摘要
目的:评估一期前路病灶清除植骨内固定治疗多节段胸椎结核的疗效和安全性。方法:对22例胸椎多节段结核患者,实施前路病灶彻底清除、椎间植骨、一期前路内固定术。植骨材料选用肋骨、髂骨或充填自体骨的钛网。术后随访12-24月,观察术后局部疼痛缓解、结核复发、ASIA分级、后凸畸形矫正及胸椎稳定性情况,并对治疗结果进行回顾性分析。结果:所有患者术后局部疼痛消失,胸椎结核复发2例(9.1%),经再次清创和系统抗结核治疗后痊愈,植骨融合时间6-12个月,胸椎后凸畸形平均矫正67.3%±10.3%,术前8例神经功能损害患者术后得到不同程度的恢复:ASIA分级B级2例,其中一例恢复到C级,一例无改变;C级6例恢复至D级1例,E级5例。所有病例无假关节形成,无内固定失败。结论:一期前路病灶清除植骨内固定能彻底清除结核病灶,充分减压,矫正胸椎后凸畸形,提高胸椎融合率,是一种治疗多节段胸椎结核的安全有效方法。
Objective： To evaluate the results and security of the first stage inner-body auto-grafting fusion and anterior internal fixation followed by anterior radical debridement in surgical management of multi-segment thoracic spinal tuberculosis.Methods：22 patients followed-up for 12-24 months were treated with anterior radical debridement and decompression,inner-body fusion with iliac,costal bone or titanium cage bone grafting and anterior internal fixation.Relief of local pain,spinal tuberculosis recurrence,the ASIA grade,kyphosis correction and spinal stability were evaluated.The clinic results were analyzed retrospectively.Results：All patients acquired elimination of location pain post-operation.Thoracic spinal tuberculosis recurrence was observed in two cases（9.1%）and recovery was obtained by re-debridement and regular chemotherapy.All cases got inner-body fusion from 6 to 12 months post-operatively.The average correction rate of the kyphosis deformity was 67.3%±10.3%.of the 8 patients with paraplegia,the ASIA scale was used to evaluate before and after operation.of 2 grade B patients,1 improved to C and 1 unchanged;of 6 grade C patients,5 improved to D and 1 to E.No pseudoarticulation and failure of internal fixation occurred in all cases.Conclusion： the first stage anterior debridement and stabilization with inner-body autografting fusion and internal fixation in surgical management of multi-segment thoracic spinal tuberculosis can get fully focus clearance,complete decompression,correct of the kyphosis deformity and improvement of the fusion rate.It is a safe and effective method to treat multi-segment thoracic spinal tuberculosis.
出处
《川北医学院学报》
CAS
2011年第3期231-234,共4页
Journal of North Sichuan Medical College
关键词
结核
胸椎
多节段
骨移植
内固定器
Tuberculosis
Thoracic vertebra
Multi-segment
Bone grafting
Internal fixation
