Objective To invcstigatc the clinical results and significance of one-stage radical eradication,vertebral osteotomy and instrumentation fixation in the treatment of lumbar spine tuberculosis associated with marked kyphosis demormity through a purely postcrior procedure. Methods Twenty-one cases with lumbar spine tuberculosis associatcd with marked kyphosis demormity were treated by one-stage radical eradication,vertebral osteotomy and instrumentation fixation through posterior procedure. In the group,there were 13 males and 8 females,aging from 25～65 years old with the mean age of 40.1 years. The lesions involved 1 to 2 segments in 12 cases and more than 2 segments in 9 cases. The preoperative average Cobb angle of kyphosis was 66.8°(range from 38°～ 106°). There were 10 cases with neurological dysfunction which the Frankel＇s classification was C in 3 cases and D in 7 cases. Results The average blood loss during the operation was 9 0 0 mL ( range from 5 0 0 to 2 0 0 0 mL ) , and the average operation time was 3.3 hours(range from 2.3 to 4. 1 hours). The postoperative neurological improvement was obtained. The postoperative average Cobb angle was 15. 1°,and the corrective rate was 77.4％. The followed-up was ranged from 12 to 48 months with an average of 26 months. There were no major complications related to the fixations ,loss of correction and the fusion were achieved in all patients. Conclusion The operation way is an ideal method to treat the lumbar spine tuberculosis associated with marked kyphosis demormity.%目的 探讨一期后路病灶清除、截骨矫形治疗伴明显后凸畸形的腰椎结核的临床效果及意义.方法 对2002年1月至2008年11月间我院治疗的21 例伴有明显后凸畸形的腰椎结核患者采取一期后路病灶清除、楔形截骨矫形及内固定术.男13 例,女8 例,年龄25～65 岁,平均40.1 岁.累及1～2个椎体者12 例,3个及以上椎体者9 例.术前后凸角38°～106°,平均66.8°.10 例合并神经损害,3 例为Frankel C级,7 例为Frankel D级.结果 手术时间为2.3～4.1 h,平均3.3 h,术中出血500～2 000 mL,平均900 mL.无严重并发症发生,术后神经功能均获显著改善.术后后凸角度平均15.1°,矫正率为77.4%.随访12～48个月,平均26个月.无内固定松动、断裂及明显矫正度丢失,融合良好.结论 对伴有明显后凸畸形的腰椎结核患者采取一期后路病灶清除、截骨矫形术效果满意.
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