摘要
[目的]评价前路单钉棒系统内固定在超长节段相邻多椎体脊柱结核治疗中的应用价值。[方法]2007年3月～2009年12月对9例胸腰椎超长节段相邻多椎体结核患者行前路一期病灶清除植骨融合,单钉棒内固定治疗。术前采用标准化疗方案,术中彻底清除病灶、椎体间植骨,椎体侧前方单钉棒系统固定重建脊柱稳定,术后规则抗痨治疗18个月。[结果]全部病例得到随访16～48个月,平均27.3个月。8例1次治愈;1例复发并窦道形成,经再次病灶清除后治愈。术后3～5个月血沉及C反应蛋白逐渐恢复正常。术后融合节段后凸角17.3°±4.4°,终末随访时畸形矫正角度丢失3.4°±2.2°。CT证实植骨于术后3个月开始出现融合,随访期间未发生植骨块或内固定松动移位。6例不完全截瘫患者术后12个月神经功能恢复正常。[结论]超长节段相邻多椎体结核病变范围广,侵犯椎体多、破坏重,脊柱稳定性差。前路病灶清除、植骨融合并单钉棒内固定具有重建脊柱的稳定性、提高植骨融合率、达到早期安全功能锻炼及降低总体医疗费用等优点,为该类患者的外科治疗提供选择,具有较高的临床应用价值。
[Objective]To evaluate the method and clinical effect of anterior focus clearance with autograft bone fusion and internal fixation in treating long-segment adjacent multivertebral tuberculosis. [Methods]During March 2007 to September 2009,9 patients underwent anterior focus clearance with autograft bone fusion and internal fixation via thorax in treating thoracic vertebra tuberculosis.Six were male and 2 were female.The average age was 32 years old（range,20 to 42）.The highest segmen was the fifth thoracic vertebra and the lowset was the second lumbar vertebra.Twenty-nine patants had thoracic vertebra disease and 11 cases had lumbar vertebra.Five had 5 vertebra lesions.All patients had different kyphosis,and the average kyphosis angle was 24.30.All patients received antituberculous therapy 4-6 weeks before operation. [Results]All patients were followed up for 16～48 months,8 were recovered after first operation,one had recurrenu.The average Cobb angle of postoperation kyphosis was 7.5°±4.2°.The loss of correction Cobb angle was 3.2°± 1.6° at last follow up.The bone fusion started months after operation on CT scans.Six patunts with titanium had different recovery after 12 months postoperatirely. [Conclusion]Long-segment adjacent multivertebral tuberculosis had a broad lesion and unstable multivertebrae.The treatment of adjacent multivertebral tuberculosis by anterior focus clearance,intervertebral autograft and internal fixation in one stage is effective.Our current study indicates that anterior bone fusion and internal fixation in one-stage can correct kyphosis effectively and rebuild spinal stability.It is a good choice for surgical treatment for long-segment adjacent multivertebral tuberculosis.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2011年第21期1773-1776,共4页
Orthopedic Journal of China
关键词
内固定器
脊柱结核
外科手术
internal fixation
spinal tuberculosis
surgery
