一期后路病灶清除椎间植骨融合内固定术治疗跳跃型胸腰椎结核的临床研究

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[摘要] 目的 探讨一期后路病灶清除椎间植骨融合内固定术治疗跳跃型胸腰椎结核的临床疗效及安全性。 方法 选择我院2006年5月～2011年11月收治的脊柱结核患者50例进行回顾性分析，手术前、后检查X线片测量椎间隙高度、畸形矫正等情况。术后所有病例均常规佩戴腰围严格限制腰椎活动3个月、抗结核治疗9～18个月。观察临床疗效及椎间融合情况。 结果 术后随访12～32个月，平均18个月。患者手术切口一期愈合44例，4例术后1～3个月结核窦道形成，2例复发，术前平均后凸角11.8°，术后平均后凸角2.4°，平均矫正8.4°。除1例窦道形成继续换药、2例复发行侧前路病灶清除术外，其余47例6个月内均达结核愈合标准，治愈率为94%。 结论 一期后路病灶清除联合单节段椎间植骨融合内固定手术，疗效明确，是治疗下腰椎结核可行的方法之一。

[关键词] 一期；后路；胸椎；腰椎；结核；脊柱；内固定器；清创术；骨移植；脊柱融合术

[中图分类号] R529.2 [文献标识码] A [文章编号] 1673-7210（2012）08（c）-0028-03

Clinical study of single-stage posterior debridement, interbody bone grafting, internal fixation in treatment of thoracic and lunmbar multilevel noncontiguous spinal tuberculosis.

MA Bin DAI Chonghua

Department of Orthopedics, the People′s Hospital of Luliang County, Yunnan Province, Luliang 655600, China

[Abstract] Objective To explore the clinical effectiveness and safety of surgical management single-stage posterior debridement, interbody bone grafting, internal fixation in treatment of throracic and lunmbar multilevel noncontiguous spinal tubercylosis. Methods A consecuing series of 50 cases of spinal tubercylosis from May 2006 to November 2011 were studied retrospectively. The height of vertebrae interval and deformity were measured before and after the surgery by X-ray. All the cases normally wore waist bellyband to strictly limited lumbar activity for 3 months and had been antituberculosis therapy for 9-18 months. Lumbar interbody fusion and the effectiveness were observed. Results All the cases had been followed for 12-32 months postoperatively, the average follow-up period was 18 months. Operative incisions of 44 cases were primary healing. 4 cases appeared tuberculous sinus after operation for 1 to 3 months, and 2 cases recurred. Preoperative average posterior convex angle was 11.8°, while it achieved 2.4° postoperatively, and 8.4° was corrected. The rest of the 47 cases met the standards of tuberculosis healed within 6 months with 94% recovery rate, except 1 case continued dressing change for sinus formation and 2 cases had anterior-lateral debridement for recurrence. Conclusion Single-stage posterior debridement combined with single segment interbody bone grafting and internal fixation is an effective method, and it is one of feasible method to treat the tuberculosis of lumbar spine.

[Key words] Single-stage; Posterior; Thoracic; Lumbar; Tuberculosis; Spine; Internal fixation; Debridement; Bone graft; Spinal fusion

脊柱结核多是肺结核的继发感染引起，当人感染结核杆菌后多首先侵犯肺，俗称肺结核，经过积极治疗或体质强、抵抗力强时，肺结核可治愈或自已痊愈。而另一部分结核杆菌以血液传播的途径传到身体的各部骨处[1]。当抵抗力下降或劳累等原因则会继发结核感染，发生于脊柱处，即为脊柱结核。脊柱内有传导神经，是人的传导通路[2]。当患上脊柱结核后必然影响传导，出现局部麻木、疼痛、僵硬等症状。近年，脊柱结核发病率呈上升趋势，但是椎体跳跃受累者并不常见，且针对性的治疗报道也相对较少，手术术式的选择也尚未统一。本文笔者根据2006年5月～2011年11月收治的脊柱结核患者50例进行治疗分析，现将材料总结如下：