目的 探讨一期后路椎弓根钉内固定矫形加前路病灶清除、钛网植骨支撑融合治疗胸腰椎结核的安全性及临床疗效.方法 回顾性分析2005年1月至2010年6月我院一期后路椎弓根钉内固定矫形加前路病灶清除、钛网植骨支撑融合治疗胸腰椎结核32例,患者术前术后均行VAS疼痛评分,按照Frankel分级评定患者的神经功能,根据影像学检查结果评价植骨融合时间、术后及随访期内矫正角度及椎体高度变化情况.结果 32例患者术后随访时间14～40个月(平均24个月).全部患者均获骨性融合,平均时间为4.8个月,无局部复发；神经功能Frankel分级均有不同程度恢复,术前A级1例,B级5例,C级4例,D级16例,其余均为E级.术前、术后Cobb角平均为30.4°、19.4°(比术前纠正11°)椎体高度平均恢复10.1 mm,平均丢失2.3mm.腰背疼痛症状明显改善,VAS评分为2.6分；神经功能改善情况,Frankel分级除1例A级、3例D级外,其余均为E级,复查血沉正常.结论 一期后路椎弓根钉内固定矫形加前路病灶清除、钛网植骨支撑融合治疗胸腰段结核可有效缓解患者疼痛、改善神经功能、清除病灶、恢复和保持椎体高度、矫正后凸畸形.%Objective To evaluate the clinical efficacy and safety of one-stage posterior pedicle screw instrumentation followed by anterior debridement and titanium-meshes bone grafting for the treatment of thoracolumbar tuberculosis. Methods We retrospectively reviewed of the clinical data of 32 patients with thoracolumbar tuberculosis treated with one-stage posterior pedicle screw instrumentation followed by anterior debridement and titanium-meshes bone grafting from Jan 2005 to Jun 2010. The neurological function (based on Frankel grading system), JOA score, Cobb angle of kyphosis and the height of the vertebrae were measured preoperatively and at 2 weeks postoperatively. Results The 32 patients were followed up for 14-40 months, with a mean of 24 months. All the patients got fusion of bone after an average period of 4.8 months, without local recurrence, and had the neurological function recovered to some extent. Cobb angle of kyphosis was 19.4° postoperative, improved 11° compared with that pre-operative. The height of the vertebrae was recovered for 10.1 mm, with a loss of 2.3 mm in average. Significant pain relief was observed and the VAS score were increased. All the cases had normal ESR after the surgery. Conclusion One-stage posterior pedicle screw instrumentation followed by anterior debridement and titanium-meshes bone grafting can effectually relieve the pain, improve the neurological function, rebuild the stability of spine, promote the intervertebral fusion, and recover the incomplete paraplegia.
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