摘要
目的:评价不同内固定方式一期治疗胸腰椎结核的临床疗效。方法:2003年1月至2007年8月间采用不同内固定方式治疗胸腰椎脊柱结核患者23例,其中经前路病灶切除、椎体间植骨并Z-plate钢板内固定5例,侧方钉棒系统内固定8例,后路内固定并前路病灶切除、椎体间植骨10例。所有内固定材料均为钛合金。植骨方式包括自体肋骨移植、自体髂骨移植、异体骨块移植以及自体肋骨和异体骨块混合移植。23例患者中伴有后凸畸形15例,不完全性截瘫8例,完全性截瘫2例,病变累及3个及3个以上椎体者5例,累及2个椎体者14例,累及1个椎体者4例。结果:所有23例患者切口均一期愈合,无慢性窦道形成。23例均获得随访,随访时间6-36月(平均16月),结核无局部复发,后凸畸形平均矫正18.5°。随访期内,有3°左右的角度丢失。植骨界面骨性融合时间平均4月。结论:采用一期病灶切除、椎体间植骨并前、后路内固定治疗胸腰椎脊柱结核,可以达到较好的治疗效果,但应根据患者具体情况选择合适的内固定方式和植骨方式。
Objective： To evaluate the clinical effect of the one-stage management of thoracic-lumber tuberculosis with different fixation methods.Methods： A total of 23 patients with thoracic-lumber tuberculosis were treated with different fixation between January 2003 and August 2007.Among them,5 patients were treated with Z-plate and 8 patients with pedicle screw system after radical focus debridement and bone grafting through anterior approach;10 patients were treated with posterior internal fixation after radical focus debridement and bone grafting through anterior approach.All internal fixation materials were titanium alloy.Grafting methods included rib grafting,ilium grafting,allografting and mixed grafting.Among the 23 patients,15 had kyphosis deformity,8 patients had incomplete paraplegia,2 patients had complete paraplegia,5 patients＇ foci involved 3 or more centrums,14 patients＇ foci involved 2 centrums,and 4 patients＇ foci involved 1 centrum.Results： The incisions were primarily healed ...更多at the first stage,without sinus tract forming.All patients were followed-up from 6 to 36 months（16 months of mean time）.No local tuberculosis relapsed;Kyphosis angle was corrected by 18.5 degree of mean angle and about 3 degree lost during the follow-up;the grafting fusion at the interface took a mean time of 4 months.Conclusion： Surgical treatment of bone grafting and radical debridement and internal fixation shows good effect in thoracic-lumber tuberculosis patients,but the grafting method and internal fixation system selected should be based on the patients＇ condition.
出处
《武汉大学学报（医学版）》
CAS
北大核心
2009年第5期644-646,649,共4页
Medical Journal of Wuhan University
关键词
胸腰椎结核
植骨
内固定
Thoracic-Lumber Tuberculosis
Bone Grafting
Internal Fixation
