【摘要】 目的探讨胸、腰椎结核一期病灶清除加植骨融合内固定的疗效。方法本组30例,男16例,女14例;平均年龄32.4岁(17～55岁)。病变部位:胸椎9例,胸、腰段6例,腰椎15例。2个椎体21例,3个椎体7例,4个椎体1例,跳跃型1例。椎旁脓肿24例,髂窝流注性脓肿6例。本组患者伴有后凸畸形26例,平均Cobb角42.8°。术前血沉介于34～142mm/h。本组患者术前常规抗痨(异烟肼、利福平、乙胺丁醇、链霉素)1～2周,手术方式为一期病灶清除、脊髓减压、前方钛网支撑畸形矫正、自体髂骨(或肋骨)植骨融合内固定术。术后继续抗痨治疗12个月,定期复查胸腰椎正侧位片、血沉、肝肾功能等。结果切口皆一期愈合,无窦道形成。随访6～36个月(平均12个月),畸形矫正、植骨融合满意,未见内固定失败,疼痛等症状消失,脊髓功能皆明显恢复。2例出现神经根刺激症状,3例感伤口区麻木。术后血沉恢复正常时间平均为3～11个月。结论胸、腰椎结核行一期病灶清除、脊髓减压、植骨融合,同时前方钛网支撑畸形矫正和内固定治疗,在临床上取得了满意的疗效且不良反应少。更多还原

【Abstract】 Objective To observe the efficacy of one-stage radical debridement,defornity correction,interbody fusion and stability reconstruction with cage for the spinal tuberculosis treatment.Methods There were 30 cases in the group,16 males and 14 females with an average age of 32.4 years (17 ～ 55 years).The lesions were located at thoracic in 9 cases,thoracolunbar in 6 cases and lumbar in15 cases.Two vertebras were affected in 21 cases,three in 7 cases and four in 1 case.24 cases had para-vertebral abscess,and 6 had psoas abscess.The cases were all associated with kyphosis deformity with an average C0bb angle of 42.8 degrees.The preoperative ESR was ranged 34 ～ 142 mm/h.All the patients accepted 1 ～ 2 weeks Anti-TB therapy,then underwent one-stage radical debridement,abscess drainage,spinal cord decom-pression,deformity correction,interbody and stability reconstruction with cage through anterior approach.After the surgery,they accepted another 12 ～ month Anti-TB therapy and took image,ESR and the liver function examinations at intervals.Results All the patients acquired satisfactory incision healing.Follow-up period extended from 6 months to 36 months (mean 12months).The graft got fusion and there was no internal fixation failure or recurrence.Pain got dissapeared and neurological function was improved in all patients in different degrees.Two cases had nerve roots incitement symp-tom,and three cases felt anaesthesia at the crea of operation.There was no pyothorax or late neurological deficit.The postoperative ESR became normal 3 ～ 11 months later.Conclusion The technique of one-stage radical de-hridement,deformity correction,interbody fusion with cage for the treatment of spinal tuberculosis acquires sat-isfactory curative effect.There is no complication caused by internal fixation in the tuberculosis spondylitis treat-ment.更多还原