摘要
目的探讨经后外侧路一期病灶清除植骨融合内固定治疗胸腰椎结核伴巨大寒性脓肿的临床疗效。方法采用后外侧路一期病灶清除椎间植骨融合内固定的手术方式治疗胸腰椎结核27例。术前正规抗结核化疗4～6周,术中彻底的清除病灶,对于骨缺损采用自体髂骨或多根肋骨支撑植骨修复,同时行后路钉棒系统内固定,术后卧床4～6周,继续正规化疗至少12个月。结果 27例患者术中均未出现脊髓、神经、血管等严重的并发症。1例结核脓肿复发,于术后40 d再次进行病灶清除、植骨融合术。所有患者术后随访6～24个月,平均15.1个月,结核病灶愈合良好,死腔消失,所有植骨均获骨性融合,内固定无松动、拔出、断裂,脊髓神经Frankel分级均达到E级。结论对胸腰椎结核行后外侧路一期病灶清除植骨融合内固定可有效地重建脊柱稳定性,矫正和预防脊柱后凸畸形,获得良好的骨性融合,临床疗效可靠。
Objective To assess the efficacy of posterolateral one-stage debridement,bone grafting and internal fixation in treatment of thoracolumbar spinal tuberculosis with giant cold abscess.Methods Twenty-seven patients with thoracolumbar spinal tuberculosis and giant cold abscess were treated by posterolateral one-stage debridemen,bone grafting and internal fixation.All the patients received regular anti-TB chemotherapy for 4-6 weeks preoperatively,and the lesions were completely cleared intraoperatively.For bone defects,autogenous iliac or multi-ribs were used to support graft repair,and anterior screw-plate or screw-rod fixation was applied.All the patients lie in bed for 4-6 weeks,and the regular chemotherapy was continued for at least 12 months.Results There were no severe intraoperative complications in all patients.One case had a recurrent tuberculous abscess,and underwent focus clearance and bone graft again at 40 days after operation.All patients were followed up for 6-24 months（average 15.1 months）,and tuberculosis was successfully healed.All cases had evidence of solid bony fusion without instrument failure and recovered to Frankel grade E.Conclusion Posterolateral one-stage debridement,bone grafting fusion and internal fixation has a reliable clinical effcacy in the treatment of thoracolumbar spinal tuberculosis,and can efectively reconstruct spinal stability,correct and prevent kyphosis and obtain good grafting fusion.
出处
《实用临床医学（江西）》
CAS
2011年第6期38-41,共4页
Practical Clinical Medicine
关键词
胸椎
腰椎
结核
寒性脓肿
骨移植
内固定器
thoracic vertebrae
lumbar vertebrae
tuberculosis
cold abscess
bone graft
internal fixation
