一期前路病灶清除钛笼植骨内固定术治疗下颈椎结核

One-stage anterior debridement, titanium cage fusion with autograft and instrumentation for lower cervical spinal tuberculosis

中文关键词:  脊柱结核  下颈椎  一期病灶清除术  钛笼植骨  内固定

英文关键词:Spinal tuberculosis  Lower cervical  One-stage anterior debridement  Titanium cage fusion with autograft  Instrumentation

中文摘要:

  【摘要】 目的：探讨一期前路结核病灶清除钛笼植骨内固定治疗下颈椎结核的疗效。方法：2006年12月~2010年7月手术治疗下颈椎结核患者10例，男6例，女4例；年龄42~71岁，平均52.1岁。病灶累及2个椎体者7例，其中C3~C4 1例，C4~C5 1例，C5~C6 3例，C6~C7 2例；累及3个椎体者3例，均为C5~C7。术前均存在不同程度的颈部疼痛、低热、盗汗，6例患者伴有四肢感觉运动功能障碍，神经功能按Frankel评级：B级1例，C级2例，D级3例，E级4例。5例伴有寒性脓肿，脓液均未穿破后纵韧带。术前后凸Cobb角10°~30°（19.1°±5.1°）。术前应用抗结核药物治疗至少2周，均采用一期前路结核病灶清除钛笼植骨内固定手术，术后继续抗结核治疗6~12个月。随访观察患者临床症状改善和植骨融合情况。结果：手术均顺利完成，术中无大血管、脊髓、食道、气管损伤。切口均一期愈合，未发生感染及窦道形成。随访10~24个月，平均14.5个月，患者临床症状均改善，伴神经功能障碍患者均有不同程度的改善，1例从B级恢复到D级，其余均恢复至E级。颈椎后凸畸形矫正良好，术后1周后凸Cobb角为0°~5°（2.9°±1.6°），较术前明显减少，差异有统计学意义（P＜0.01）；末次随访时后凸Cobb角为0°~7°（4.7°±2.3°），与术后即刻比较差异无统计学意义（P＞0.05）。术后3~6个月均显示良好的骨性融合征象，末次随访时钛笼植骨与上下椎体间完全融合，无内固定松动、脱落、折断等并发症。结论：在规范抗结核治疗的基础上，一期前路结核病灶清除钛笼植骨内固定治疗下颈椎结核是一种安全有效的方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of one-stage anterior debridement, titanium cage fusion with autograft and instrumentation for lower cervical spinal tuberculosis(TB). Methods: From December 2006 to July 2010, 10 patients suffering from lower cervical TB(6 males and 4 females, aged 42-71 years, mean age 52.1 years) underwent one-stage anterior debridement, titanium cage fusion with autograft and instrumentation. The defect sites were C3-C4 in 1 case, C4-C5 in 1 case, C5-C6 in 3 cases, C6-C7 in 2 cases, C5-C7 vertebrae in 3 cases. All patients had neck pain, fever, night sweats, 6 cases han limb sensory-motor dysfunction, the preoperative Frankel grade: 1 Frankel B, 2 Frankel C, 3 Frankel D, 4 Frankel E. 5 of them with cold abscess had no perforation to the posterior longitudinal ligament. The mean preoperative kyphosis angle was 19.1°±5.1°(ranged from 10° to 30°). Preoperative anti-TB treatment was given for at least 2 weeks, then the treatment lasted for 6-12 months postoperatively. Improvement of clinical symptoms and bone fusion were followed up. Results: The operations were successfully completed without injury of blood vessels, spinal cord, esophagus and trachea. The incision healed with no complications such as sinus formation and wound infection. The mean follow-up was 14.5 months ranged from 10 to 24 months. The patients′ clinical symptoms and the neurological dysfunction had different degrees of improvement, 5 cases combined with neurological deficits improved to Frankel E, 1 case improved from Frankel B to Frankel D. The kyphosis was corrected well. The average kyphosis angle of cervical spine was 2.9°±1.6° after 1 week of operation, which was significantly lower than preoperative one(P＜0.01); and 4.7°±2.3° at the final follow-up, which remained no change with 1 week postoperatively(P＞0.05). After 3-6 months postoperatively, all cases were showed signs of bone fusion. All cases were observed fully integrated titanium cage bone graft between the upper and lower vertebrae at the final follow-up, and no recurrence or instrument failure was noted. Conclusions: On the premise of standard anti-tuberculosis chemotherapy, one-stage anterior debridement, titanium cage fusion with autograft and instrumentation for lower cercical spinal tuberculosis is a safe and effective surgical method.