改良后路病灶清除打压植骨内固定治疗胸腰椎结核

Modified posterior debridement，compact bone graft and internal fixation for thoracolumbar tuberculosis

中文关键词:  脊柱结核  病灶清除术  打压植骨  内固定  后路

英文关键词:Spine tuberculosis  Debridement  Compact bone graft  Internal fixation  Posterior approach

中文摘要:

  【摘要】目的：探讨改良后路病灶清除打压植骨内固定治疗胸腰椎结核的可行性及疗效。方法：2005年1月~2010年3月收治的胸腰椎结核患者中，对17例连续2个节段病变的患者采用改良后路病灶清除、打压植骨、短节段内固定术。T12~L1 4例，L1~L2 7例，L2~L3 6例。影像学检查均有椎旁小脓肿；术前后凸Cobb角22°～50°，平均31.2°；均伴神经功能障碍，ASIA分级C级9例，D级8例。术前、术后常规抗结核药物治疗和营养支持治疗。结果：患者均顺利完成手术，术中无脊髓、大血管及重要脏器损伤。手术时间155.4±21.6min，出血量511.8±98.2ml，输血量164.7±157.9ml，住院时间14.7±1.0d。术后2例患者出现神经根性刺激症状，1～2周后症状缓解；1例术后半年原切口皮下寒性脓肿形成并溃破，经换药治疗后痊愈。随访13~47个月，平均30个月，术后和末次随访时的Cobb角分别为13.0°±5.6°和14.8°±5.8°，矫正率和丢失率分别为58.3％、5.8％。术后4~7个月植骨均愈合，随访期间内固定无松动、断裂及脱落，均无结核复发。末次随访时3例术前ASIA C级患者恢复至D级，余均恢复至E级。结论：对连续2节段胸腰椎（T12～L3）结核患者在有效抗结核药物治疗的前提下采用改良后路病灶清除打压植骨内固定术安全、有效。

英文摘要:

  【Abstract】　Objective：To evaluate the feasibility and efficacy of the modified posterior debridement，compact bone graft and internal fixation for thoracolumbar tuberculosis.Method：From January 2005 to March 2010，17 patients with 2 consecutive segments tuberculosis in thoracolumbar spine were reviewed retrospectively.All cases underwent modified posterior debridement，compact bone graft and short-segment internal fixation.Among them，there were 4 T12-L1，7 L1-L2，and 6 L2-L3.Imaging examination revealed small amounts of paraspinal abscess.Cobb angles before surgery were 22°-50°（average，31.2°）.All cases presented with neurological deficit prior to surgery，based on ASIA scale，there were 9 grade C and 8 grade D.Antituberculosis chemotherapy and nutrition supplement were performed routinely before and after surgery.Result：All operations were performed successfully with no neurovascular or major organ injury noted.Operation time was 155.4±21.6min；the amount of blood loss was 511.8±98.2ml；and the amount of transfusion was 164.7±157.9ml.Days of hospitalization were 14.7±1.0d.2 cases were complicated with nerve irritation，which was resolved 1-2 weeks later；1 case developed sinus at skin incision，which was resolved with corresponding drainage.All patients were followed up for an average of 30 months（range，13-47 months）.The Cobb angle at after operation and final follow-up was 13.0°±5.6° and 14.8°±5.8° respectively，with the rate of correction and loss of correction of 58.3％ and 5.8％ respectively.All cases got solid bony fusion at 4-7 months postoperation.During follow-up，no instrument failure and recurrence of tuberculosis were noted.3 cases suffering from neurological deficit recovered to grade D，while the others with normal neurofunction recovered to grade E at final follow-up.Conclusion：Modified posterior debridement，compact bone graft and internal fixation is reliable for 2 consecutive thoracolumbar（T12-L3） tuberculosis.