摘要
目的总结采用一期前路病灶清除,重建脊柱前中柱功能的方法治疗胸腰椎结核的临床效果。方法2001年1月-2007年1月,对收治的65例胸腰椎结核患者行一期前路病灶清除、减压,自体骨植骨及前路钢板内固定治疗。男43例,女22例;年龄19～64岁,平均40.2岁。病程3个月～10年,中位病程10个月。其中胸椎结核(T4～10)18例,胸腰椎结核(T11～L2)44例,腰椎结核(L3～5)3例。其中病变累及单节段7例,2个节段54例,3个节段4例。14例合并脊髓损伤者Frankel分级为:C级5例,D级9例。脊柱后凸畸形Cobb角为20～65°,平均41°。结果手术时间120～210min,平均170min;术中出血量300～1500mL,平均600mL。术后58例获随访,随访时间1～6年,平均23个月。术后40d及3个月分别出现1例切口脓肿,经对症处理后切口愈合;其余患者切口均Ⅰ期愈合。X线片检查示术后4～12个月,平均6个月植骨达骨性融合;无结核复发。术后12个月患者腰背部疼痛症状消失,14例合并脊髓损伤患者Frankel分级为D级7例,E级7例。术后12个月脊柱后凸畸形Cobb角为0～33°,平均24°,与术前比较差异有统计学意义(P<0.05)。结论早期重建脊柱前中柱的承重功能和稳定性在脊柱结核治疗中具有重要意义。经严格抗结核治疗后,行一期前路病灶清除,重建脊柱前中柱功能是治疗胸腰椎脊柱结核的一种安全有效的方法。
Objective To summarize the effect of one-stage anterior debridement of infection in function reconstruction of anterior and middle column for the treatment of thoracolumbar spinal tuberculosis.Methods From January 2001 to January 2007,65 patients with thoracolumbar spinal tuberculosis were treated with one-stage anterior debridement,decompression,autogenous bone grafts and internal fixation.There were 43 males and 22 females with an average age of 40.2 years（range,19-64 years）,including 18 cases of thoracic tuberculosis（T4-10）,44 cases of thoracolumbar tuberculosis（T11-L2）and 3 cases of lumbar tuberculosis（L3-5）.The disease course was 3 months to 10 years（median 10 months）.One segment was involved in 7 cases,two segments in 54 cases and three segments in 4 cases.In 14 cases with spinal cord injury,there were 5 cases of grade C and 9 cases of grade D according to Frankel classification.The kyphotic Cobb angle was 20-65°（41°on average）.Results The operative time was 120-210 minutes（170 minutes on average）,and the blood loss was 300-1 500 mL（600 mL on average）.Fifty-eight patients were followed up for 1-6 years（23 months on average）.Abscess occurred in 2 cases at 40 days and 3 months,and healed after symptomatic management.The other incisions achieved healing by first intention.The X-ray films showed bony fusion 4-12 months（6 months on average）after operation.No tuberculosis recurred.At 12 months after operation,pain disappeared,and there were 7 cases of grade D and 7 cases of grade E according to Frankel classification.The kyphotic Cobb angle was 0-33°（24°on average）,showing statistically significant difference（P0.05） when compared with preoperation.Conclusion Early reconstruction of load-bearing function and stability of anterior and middle column in the treatment of spinal tuberculosis is great significant.The application of one-stage anterior surgery with debridement,decompression,autogenous bone grafts and internal fixation in the operative treatment of thoracolumbar tuberculosis is safe and effective after a rigorous anti-tuberculosis treatment.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期37-40,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
脊柱结核
胸腰椎
病灶清除
内固定
脊柱重建
Spinal tuberculosis Thoracolumbar vertebrae Debridement Internal fixation Spine reconstruction
