一期后路结核病灶清除、椎体间支撑植骨及矫形内固定治疗胸腰椎结核

摘要

Objective To investigate the clinical outcome of one-stage posterior debridement, interbody grafting and internal fixation for thoracolumbar tuberculosis. Methods Clinical data of 25 patients with thoracolumbar tuberculosis, treated from January 2004 to March 2010 in Guangzhou General Hospital of Guangzhou Military Command, were analyzed retrospectively. All patients underwent one-stage posterior debridement, interbody grafting and internal fixation. Operation time, intraoperative estimate blood loss, hospital stay, American Spinal Injury Association (ASIA) grading and Cobb angle before and after surgery, bony fusion, tuberculosis recurrence and perioperative complications were evaluated. Results The average operation time was 390 min (240-440 mL), the average intraoperative estimate blood loss was 858 mL (200-1 600 mL) , the average hospital stay was 18 d (14-25 d). All patients were followed up for 12 to 62 months with the average of 25.2 months. During the follow-up, recurrence of tuberculosis and internal fixation breakage was found in one case, and then was cured by secondary posterior debridement, internal fixation and anti-tuberculosis treatment. The remains of cases had the evidences of solid bony fusion. For 10 patients with neurological deficit, spinal cord function all improved from preoperative ASIA grade D to postoperative ASIA grade E. For 12 patients with kyphosis, Cobb angle decreased from (24 ± 13)° preoperatively to (8 ± 5)° one week after the surgery, and was (12 ± 7)° at the final follow-up, the differences between preoperation and postoperation had statistical significance (P <0.05). Conclusion One-stage posterior debridement, interbody bone grafting and instrumentation is an alternative choice for thoracolumbar tuberculosis because it could obtain satisfactory deformity correction effect with thorough debridement and high bony fusion rate.%目的：探讨一期后路结核病灶清除、椎体间支撑植骨及矫形加压内固定治疗胸腰椎结核的临床疗效。方法回顾性分析2004年1月至2010年3月广州军区广州总医院采用后路病灶清除、椎体间支撑植骨及矫形加压内固定手术治疗的25例胸腰椎结核患者的临床资料。评价指标包括手术时间、术中出血量、住院时间、术前及末次随访美国脊髓损伤学会（ASIA）分级、手术前后及随访时Cobb角、围手术期并发症、骨性融合及结核复发情况。结果手术时间240～440 min，平均手术时间390 min；术中出血量200～1600 mL,平均术中出血量858 mL；住院时间14～25 d，平均住院时间18 d。患者获得12～62个月随访，平均随访时间25.2个月。1例术后1年半时结核复发、内固定断裂，再次行手术及抗结核治疗后痊愈；其余病例均骨性愈合。术前10例神经功能障碍患者ASIA分级均为D级，末次随访时均恢复至E级；12例后凸畸形患者术前Cobb角（24±13）°，术后1周恢复至（8±5）°，末次随访时达（12±7）°，手术前后比较，差异有统计学意义（P＜0.05）。结论一期后路结核病灶清除、椎体间支撑植骨及矫形加压内固定治疗胸腰椎结核具有病灶清除彻底、术后畸形矫正满意、骨性融合率高等特点，是治疗胸腰椎结核的一种可供选择的术式。