目的 探讨一期后路内固定前路病灶清除植骨融合术治疗胸腰段脊柱结核的手术效果.方法 对75例胸腰段脊柱结核患者均采用一期后路内固定前路病灶清除植骨融合术.其中后路采用AF内固定、前路采用自体肋骨支撑植骨8例,后路采用钉棒系统内固定、前路采用自体肋骨支撑植骨40例,后路用钉棒系统固定、前路采用钛网植骨27例.结果 手术时间150~270 min;术中失血量750~2 100 ml.术中无大血管、硬脊膜损伤.术后并发症:前路切口感染1例,脊神经根激惹1例,交感神经激惹1例,均在3个月内恢复.75例均获随访,时间20~60个月.植骨融合率:术后6个月为91.5%,术后1年为100%.末次随访时Frankel分级:B级6例均恢复至D级,C、D级37例均恢复至E级.两下肢感觉运动功能、括约肌功能均得到一定程度恢复.无内固定松动断裂,结核病灶无复发.结论 术前经过充分准备,以规范的全身抗结核治疗(化疗)为基础,加强营养支持治疗,采用后路固定前路病灶清除植骨融合术可以获得满意疗效.%Objective To observe the effect of treatment of posterior internal fixation and anterior debridement and fusion in treatment of thoracolumbar spinal tuberculosis. Methods 75 cases of thoracolumbar spinal tuberculosis were undergone posterior internal fixation and anterior debridement and fusion, in which posterior AF fixation, and autologous rib strut graft were performed 8 cases; posterior screw and rod system fixation and anterior autologous rib strut graft in 40 cases; posterior screw and rod system fixed; anterior titanium mesh plant in 27 cases. Results The operative time was 150 ~270 minutes, and intraoperative blood loss was 750 ~2 100 ml. There were no large vessels, spinal injury. Postoperative complications included f case of anterior incision infection, spinal nerve root irritation one case, and one case of sympathetic irritation. Surgical complications were less than 3 months after surgery recovery. 75 cases were followed up for 20 ~ 60 months. In six months, the fusion rate was 91. 5% , 1 year after fusion rate was 100%. Last follow up 13 cases of neurological deficit neurological function Frankel grade improvement grade 1~3(6 grade B were restored to grade D, 37 cases of Grade C and grade D were restored to E ); No internal fixation was found; spinal tuberculosis were cured without recurrence. Conclusions For the thoracolumbar spinal tuberculosis, preoperative well-preparation, standard systemic anti-TB treatment ( chemotherapy), nutritional support and posterior fixation anterior debridement and fusion can provide satisfactory results.
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