摘要
目的:评价一期病灶清除、植骨、内固定治疗脊柱结核的临床疗效。方法:回顾性分析2003年5月～2007年6月间收治的脊柱结核36例,其中男20例,女16例,年龄9岁～72岁,平均36.6岁。其中,颈椎结核2例,胸椎结核11例,胸腰段结核16例,腰椎结核6例,骶椎结核1例;累及1个节段8例,累及2个节段17例,累及3个节段9例,跳跃性结核2例。所有病例均有不同程度的椎旁脓肿,8例伴流注脓肿形成,16例患者伴不全瘫,所有病例均在全身抗结核治疗2周后手术。手术方式为:前路病灶清除、后路内固定+植骨1例,前路病灶清除、支撑植骨、前路内固定18例,前路病灶清除、支撑植骨、后路内固定8例,前路病灶清除、支撑植骨、前后路联合内固定6例,后路病灶清除、椎体间植骨、后路内固定3例。所有病例术中均在病灶清除植骨区域加用链霉素1g～2g,术后常规全身抗结核治疗超过12个月。结果:32例获得随访,术后随访6个月～4年,平均13.6个月,术后胸背、腰腿痛及局部疼痛均缓解,16例不全瘫患者除1例改善外,其余完全恢复,围手术期伤口延迟愈合2例,经局部换药后愈合,术后3个月切口部窦道形成1例,经窦道切除、局部清创、换药后伤口愈合,未见远期并发症及复发病例。植骨平均于术后6个月完全融合,融合节段矫正角度平均丢失4°。结论:根据脊柱结核病灶的部位、范围以及是否累及椎管等特点,选择合适的手术方式,一期完成病灶清除、植骨、内固定治疗能彻底清除结核病灶、同时重建脊柱稳定性,可获得满意的临床疗效。
Objective： To evaluate the clinical efficacy of one staged surgical treatment of spinal tuberculosis by debridement with bone fusion and internal fixation . Methods： The clinical results of 36 cases of spinal tuberculosis from May 2003-June 2007 were analyzed retrospectively. There were 20 males and 16 females. Their ages ranged from 9 to 72 years old,averaging 36. 6 years old. They included 2 cases of cervical vertebra tuberculosis, 11 cases of thoracal vertebra tuberculosis, 16 cases of thora- columbar vertebra tuberculosis, 6 cases of lumbar tuberculosis and 1 case of sacral vertebra tuberculosis. Among them ,8 cases involved in one vertebra, 17 cases involved in two vertebrae , 9 cases involved in three vertebrae and 2 cases are adjunction vertebrae tuberculosis. All cases were accompanied with different kinds of paraspinal abscesses, 8 cases were accompanied with soft-- tissue abscesses and 16 cases were accompanied with incomplete paralysis. Before operation, all cases were given antituberculosis drugs for more than 2 weeks. 1 case of the total underwent anterior debridement , posterior bone fusion and fixation , 18 cases underwent anterior debridement , bone fusion and fixation , 8 cases underwent anterior debridement , bone fusion and posterior fixation , 6 cases underwent anterior debridement , bone fusion , both anterior and posterior fixation , 3 cases underwent posteri- or debridement , intervertebral bone fusion and fixation . After operation, all cases were given antitubereulosis drugs for more than 12 months and their clinical outcome were reviewed retrospectively. Result： 32 cases of the total obtained 6 to 48 month＇s fol- low- up （averaging 13.6 months） , the chest--back pain ,lumbar--leg pain and tuberculosis symptoms relieved . Among 16 pa- tients with incomplete paraplegia, 15 were completely recovered and 1 was partly recovered . 2 patients had their incision healed by second intention , sinus formation was found in one patient 3 months postoperation , through local debridement and change bandage , it healed. No recurrence of spinal tuberculosis and later complications was noted in any patient during follow--up peri- od. Spinal solid fusion at the interface between the graft and adjacent vertebra was shown radiologically in 6 months on the aver- age, residual kyphosis was 4° on the average . Conclusion： Based on the segment and range of spine involved ,weather the verte- bral canal involved or not, we could select correct approach to operate. And one staged surgical treatment of spinal tuberculosis by debridement with bone fusion and internal fixation can debride focus of infection completely and reconstruct spinal stability simultaneously, and could obtain satisfactory clinical outcome.
出处
《中国伤残医学》
2008年第6期5-7,共3页
Chinese Journal of Trauma and Disability Medicine
关键词
脊柱结核
病灶清除
植骨
内固定
Spinal tuberculosis
Debridement
Spinal fusion
Internal fixation
