【摘要】 目的:评价单纯后路手术联合经椎弓根化疗一期治疗脊柱结核的临床疗效。方法:2008年8月～2017年8月我院采用单纯后路手术联合经椎弓根化疗一期治疗胸、腰椎脊柱结核16例,男10例,女6例,年龄47～68岁,平均(56.5±5.8)岁。病变部位为胸8～腰5,其中累及2个椎体8例,3个椎体6例,4个及以上椎体2例。术前依据ASIA神经功能分级标准:B级1例,C级3例,D级8例,E级4例。术前红细胞沉降率(ESR)10～193 mm/h,平均(84±34.8)mm/h,其中7例正常。术前平均后凸Cobb角度为(34.6±5.8)°(15～48°)。手术采用后入路途径一个切口进行经肋横关节侧前方椎体结核的病灶清除和后路内固定,同时经椎弓根病灶植骨并化疗。结果:所有患者除1例切口液化坏死外其余均Ⅰ期愈合,无局部窦道形成。除1例失访外,其余15例均获得1～5年随访,平均(2.2±1.1)年,全部治愈,无1例复发。后凸平均矫正度数为(18.6±2.4)°,随访期内角度丢失为2～4°。神经功能恢复明显。结论:单纯后路病灶清除植骨融合内固定术联合经椎弓根抗结核化疗一期治疗脊柱结核,能较好地纠正后凸畸形,缩短手术时间,减少出血量,且无1例复发,为脊柱结核的治疗提供了全新的思路。更多还原

【Abstract】 Objective:To evaluate the clinical efficacy of primary surgical treatment of spinal tuberculosis via simple posterior approach combined internal fixation with chemotherapy. Methods:A total of 16 cases(10 males,6 females) of thoracic and lumbar spinal tuberculosis treated by simple posterior approach with trans-pedicle fixation and chemotherapy were included from August of 2008 to 2017. The patients aged from 47 to 68 years,with an average of(56. 5 ± 5. 8) years old. The lesions were localized from the 8 ththoracic vertebra to the 5 thlumbar vertebra. Involvement of 2 vertebral bodies occurred in8 cases,3 in 6,and more than 4 in 2. Preoperative grading of the neurological function by American Spinal Injury Association( ASIA) indicated 1 patient was in grade B,3 patients were in grade C,8 in grade D and 4 in grade E. Preoperative erythrocyte sedimentation rate( ESR) was 10 ～ 193 mm/h,averaging(84 ± 34. 8) mm/h,and 7 patients were in normal level of ESR. The average Cobb’ s angle measured before operation was(34. 6 ± 5. 8) °(15 ～48°). Surgical procedure was performed by posterior approach via only one incision to clear the anterior and posterior vertebral tuberculosis combined with posterior spinal pedicle screw internal fixation and chemotherapy. Results:All patients achieved primary wound healing except for liquefaction necrosis occurring in one patient,without formation of local sinus. Follow-up was 1 to 5 years[one failure,average( 2. 2 ± 1. 1) years],and showed no single case of relapse. The mean degree of kyphosis was corrected to(18. 6 ± 2. 4) °,though the angle was lost by 2 ～ 4° during follow-up period. Nerve function was better recovered. Conclusion:Primary surgical procedure for spinal tuberculosis via simple posterior approach with internal fixation and local chemotherapy may lead to better correction of the kyphosis,greatly reduced operative time and intra-operative blood loss as well as relapse of the tuberculosis. This technique can be a new option for treatment of spinal tuberculosis.更多还原