【摘要】 目的探讨一期病灶清除、植骨、选择性内固定治疗脊柱结核伴神经损害的疗效。方法对18例脊柱结核伴神经症状患者术前均行≥3周抗结核治疗,手术行前路、后路或肾切口入路等一期病灶清除植骨及选择性内固定。术后继续抗结核治疗1年。结果患者神经损害症状术后均有不同程度恢复。1例胸腰段(T12～L1)结核患者切口延迟愈合,经清创及调整药物结合换药愈合。患者植骨均融合。复查X线片未发现脊柱失稳现象,内固定物无断裂。随访期内未见结核复发及脊柱畸形发生。结论在有效抗结核药物基础上一期病灶清除、植骨、选择性内固定治疗脊柱结核伴神经损害是安全、有效的方法。更多还原

【Abstract】 Objective To investigate the efficiency of surgical management of spinal tuberculosis with neural symptom by one stage radical debridement with bone graft and selective internal fixation.Methods 18 patients of spinal tuberculosis were treated with one stage radical debridement with bone graft and selective internal fixation with anterior or posterior or renal incision ect.All patients underwent at least three weeks of anti tuberculosis treatment before operation.Simultaneous bone grafting,and continued postoperative antituberculous therapy were done for one year.Results Nerve damage of 18 cases patients had different degree of recovery postoperatively.1 case of thoracolumbar spinal tuberculosis(T12～L1) with delayed healing of the incision was cured after debridement and adjustment of anti-tuberculosis drugs combined with changing dressing.All patients with bone grafting were fused.X-ray film showed no sign of spinal destabilization and breakage of internal fixation.No tuberculosis recurrence and spinal deformity was found during the followup period.Conclusions Radical debridement with bone(or combined with metal cage) graft and selective internal fixation in the first stage is safe and effective for spinal tuberculosis with neurological symptoms on the basis of effective antiTB drugs.更多还原