【作者】 张宏其； 王昱翔； 郭超峰； 唐明星； 刘少华； 刘金洋； 吴建煌； 王锡阳； 陈静；

【Author】 ZHANG Hong-qi,WANG Yu-xiang et al.Department of Spinal Surgery,The Xiangya Hospital of Central south University,Xiangya spinal surgery center,Changsha 410008,China

【机构】 中南大学湘雅医院脊柱外科；

【摘要】 [目的]探讨经后路一期病灶清除、植骨融合内固定矫形治疗伴后凸畸形的儿童胸腰段脊柱结核的可行性及疗效。[方法]7例胸腰段脊柱结核患儿,均伴有后凸畸形。其中男5例,女2例,年龄9～12岁。术前脊柱后凸角为35～45°,平均37.9°。Frankel分级:B级2例,C级3例,D级2例。采用经后路一期病灶清除、植骨融合加钉棒系统矫形固定治疗。[结果]术后随访27～42个月,平均34个月。切口均一期愈合,无一例结核复发。Frankel分级:4例恢复2级,3例恢复1级。术后后凸角为2～9°,较术前明显改善,最后随访时后凸角为2～12°,较术后无明显丢失。术后3月血沉均恢复正常;所有患儿均获得满意的植骨融合。[结论]一期后路病灶清除、后方植骨内固定矫形手术治疗伴后凸畸形的儿童胸腰段脊柱结核是矫正后凸畸形和预防晚期后凸畸形发生的有效方法。更多还原

【Abstract】 [Objective]To investigate the effectiveness and feasibility of surgical management of thoracolumbar tuberculosis with kyphosis in children by using one—stage posterior debridment,bone grafting and instrumentation.[Method]7 children with thoracolumbar tuberculosis accompanied by kyphosis were admitted to our hospital,of which 5 cases were male and 2 cases were female.The age ranged from 9 to 12 years.The kyphotic angle ranged from 35 to 45 degrees before operation,37.9 degrees in average.Frankel grade system was used to evaluated the neurological deficits.The results showed that there were 2 case in B grade,3 cases in C grade and 2 cases in D grade.All cases were treated with debridement,decompression, bone grafting and instrumentation by one—stage posterior approach.[Results]The mean follow—up was 34 months(range27—42 months).All incisions were healed perfect without recurrence.Frankel grade sys- tem:4 cases improved by 2 grades,3 cases improved by 1 grade.The postoperative kyphotic angle was 2 to 9 degrees and there was no significant loss of the correction at the latest follow up.The ESR decreased to normal level 3 months postoperatively.[Conclusion]One—stage posterior debridment,bone grafting and instrumentation is an effective method to treat children thoracolumbar tuberculosis with kyphosis.It can not only correct the kyphosis but also prevent the late kyphosis progress.更多还原