摘要
目的探讨颈椎前路一期手术行病灶清除，植骨融合联合前路和（或）后路内固定，联合支具、石膏等外固定对颈椎结核的疗效。方法前路或者后路手术治疗颈椎结核16例。采用颈椎前路病灶清除，自体髂骨植骨或钛网植骨融合，并行前路和（或）后路内固定；对于年幼患者则单纯采用病灶清除、植骨融合和石膏外固定术。术后患者行正规抗结核治疗。结果所有患者经2～5年随访，16例颈椎结核均治愈。所有患者在动态颈椎侧位片上均达到骨性融合，融合时间平均为5．8个月，后凸矫正角度平均32．4°。术后1个月内复查，JOA评分提高了2～10分，平均为5．7分。结论颈椎前路一期彻底病灶清除、椎管减压、联合后路和（或）前路内固定手术治疗颈椎结核，能避免经口咽入路等手术入路的并发症，同时能矫正颈椎后凸畸形或上颈椎脱位，进行颈椎稳定性重建，能增加植骨块的融合率，有利于患者早期活动和提高颈椎结核治愈率。
Objective To assess the efficacy of one-staged anterior radical debridement, decompression, and fusion with anterior and/or posterior spinal instrumentation and immobilization with frame or plaster in the treatment of cervical spine tuberculosis. Methods A total of 16 patients with cervical tuberculous spondylitis underwent anterior debridement, bone fusion, and stabilization with anterior and/or posterior approach. The juvenile patients underwent debridement, bone graft and plaster immobilization only. All cases were treated with regular antitubereulosis drugs. Resets The follow-up range was 2 to 5 years. The overall fusion rate was 100% on the dynamic cervical lateral views in 5. 8 months. The kyphosis angles were corrected postoperatively averaged 32.4°. The JOA score were increased from 2 to 10 in the first postoperative month,5.7 on average. Conclusions The transcervical retropharyngeal approach to the anterior upper cervical spine provides direct access to the lesion and avoids the potential bacterial contamination of the oral and pharyngeal cavity. The use of one-staged anterior radical debridement, decompression, and fusion with anterior and/or posterior spinal instrumentation or immobilization in the treatment of cervical spine tuberculosis is effective to correct deformity such as segmental kyphosis and atlanto-axial dislocation, to reconstruct the stability of the cervical spine, to enhance the bone graft fusion and to facilitate the early ambulation of the patients.
出处
《临床骨科杂志》
2007年第1期19-21,共3页
Journal of Clinical Orthopaedics
关键词
颈椎/外科学
结核
脊柱/外科学
内固定
骨移植
：ervical vertebrae/surgery
tuberculosis, spinal/surgery
internal fixation
bone graft
