脊柱结核的治疗

脊柱结核 内固定

一期病灶清除植骨内固定术治疗脊柱结核

厉晓龙， 王生介， 刘俊， 杨雷， 陆贝晨

（江苏大学附属常州武进人民医院骨科 213000）

摘要：[目的]讨论手术治疗脊柱结核的有效性和安全性，探讨病变椎体部分切除、植骨融合、内固定治疗脊柱结核的临床效果。[方法] 回顾性分析35例脊柱结核患者，在2003年１月～2008年1月采用前路病变椎体部分切除、植骨融合、前路或后路内固定手术治疗，其中颈椎结核2例，胸椎结核18例，腰椎结核15例，前路固定26例，后路固定9例。所有病例随访12～24个月，平均18个月。[结果] 所有患者术后切口均一期愈合，早期无局部窦道形成。2例术后3个月结核窦道形成行二次翻修外，余患者结核症状均消失，病灶全部愈合，无复发。椎体间植骨5个月融合，12例术前有神经损伤症状者Frankel分级平均提高1.5级，15例后凸畸形术后平均矫正23°。[结论]：一期病灶清除、植骨融合、前路（后路）内固定治疗脊柱结核可重建脊柱稳定性、缩短卧床时间，纠正和预防后凸畸形，是治疗脊柱结核的理想方法。

关键词：脊柱结核； 病灶清除； 内固定

One-stage debridement and intervertebral fusion with instrumentation in the treatment of spinal tuberculosis

LI xiaolong, WANG shengjie, et al.Department of Orthopaedics, Changzhou, Wujin Hospital, Jiangsu University, Changzhou 213000, China

Abstract: [object] To discuss the effectivity and safety in the treatment of spinal tuberculosis, explore the clinical significance with partial vertebretomy, grafting bone and internal fixation.

[Methods] Data of 35 patients with spinal tuberculosis undergong the operation of debridement and grafting bone and anterior or posterior internal fixtion between January 2003 to January 2008 were documented retrospectively. 2 patients with cervical, 18 patients with thoracic and 15 patients with lumber spinal tuberculosis, 26 patients via anterior approach, 9 patients via posterior approach. All patients were followed up for 12～24 months, average 18 months. Results All these patients had their incision healed by first intention without sinus formation. Recurrence were found in 2 cases after first surgery in 3 months and performed second operation, the other’s toxic symptom of tuberculosis alleviated greatly, their focus was eliminated completely, no recurrence. Interbody fusion fused 5 months later, 12 cases with neurological deficits had an improvement of neurological function postoperatively, the technique Frankel average improve 1.5 grades, 15 cases with Kyphosis deformity was corrected mean 23°. Conclusions One-stage debridement and grafting and anterior or posterior internal fixation with instrumentation in the treatment of spinal tuberculosis can reconstruct the spinal column stability, shorten the time lie in bed, correct and prevent Kyphosis deformity, the curative effect is accurate.

Key words: spinal tuberculosis debridement internal fixation

脊柱结核是脊柱外科的常见疾病，其病程长，致残率高，对患者家庭和社会造成沉重的负担。近几年来，随着内固定技术和手术技巧的发展，我院骨科对脊柱结核患者采取一期前路病灶清除、植骨、前路或后路内固定，在2003年1月～2008年1月共治疗并获得随访的颈椎、胸椎、腰椎结核患者共35例，取得满意疗效，现报道如下：

厉晓龙，1976年生，汉族，江苏省常州市人，主治医师，讲师

研究方向：脊柱外科

通讯作者：王生介

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