摘要
目的根据脊柱稳定性状况,探讨脊柱结核外科治疗的术式选择。方法1998年1月至2003年12月采用手术治疗成人胸、腰、骶椎脊柱结核100例,男57例,女43例;年龄17～75岁,平均39.4岁;病史1～60个月,平均16个月。根据结核破坏程度及手术可能带来的脊柱稳定性改变,采用不同的手术治疗方式。12例脊柱稳定性无明显破坏的病例采用单纯病灶清除术,8例脊柱稳定性部分破坏的病例采用病灶清除并植骨融合术,而80例脊柱稳定性显著破坏的病例则采用一期病灶清除、植骨融合并内固定术。结果100例患者切口均一期愈合,无慢性窦道形成。除5例失访外,其余95例均获得1～7年随访(平均2.9年)。68例前路椎体间植骨病例,界面骨性融合时间平均3.5个月。65例有后凸畸形者,后凸畸形平均矫正20.2°,随访期内丢失2°～4°。除病灶清除、植骨融合并内固定术组1例因抗结核化疗周期不足复发外,其余患者均临床治愈。32例有明显神经损害的患者术后均获得明显改善。结论脊柱稳定性在脊柱结核外科治疗中具有重要意义,根据脊柱稳定性改变选择合适的外科治疗术式,均可获得满意的临床疗效。
Objective To discuss the selection of surgical procedures for the treatment of spinal tu-berculosis according to the status of segmental stability of the spine. Methods One hundred adult patients with spinal tuberculosis were treated surgically between January 1998 and December 2003. There were 57 males and 43 females with an average age of 39.4 years and an average history of 16 months. The lesion ranged from T2 to S 2, and involved single vertebral body in 3 cases, double vertebral bodies in 66 cases, and more than two vertebral bodies in 31 cases. Of 100 cases, 32 were with neurological dysfunctions, and 65 were accompanied by kyphotic deformity with an average Cobb angels of 36.4° (20° to 48°). Preoperative chemotherapy of four drugs lasted more than two weeks. Three surgical procedures were performed according to the status of segmental stability of the spine: 12 cases without spine instability underwent single debride-ment, 8 cases of spine instability with debridement and interbody fusion, and 80 cases of significant insta-bility with debridement, fusion and internal fixation. Results All patients' incision healed without chronic infection and sinus formation. 95 patients were followed up with an average of 2.9 years ranged 1 to 77 years except 5 patients lost at follow up. 68 cases with anterior fusion achieved solid fusion in average 3.5 months. 65 cases with kyphotic deformity had an average correction of 20.2° postoperatively, and 2° to 4° loss during follow-up. 32 cases with neurological deficits had an improvement of neurological function postoperatively. One patient of L 4,5 tuberculosis treated with anterior debridement, fusion and instrumentation recurred at 7 months due to an inadequate postoperative chemotherapy of 6 months, and healed with a continuous chemotherapy for 18 months, However, satisfactory clinical results were obtained in other patients without any recurrence. A left external iliac vein was torn and repaired successfully in 1 case. Conclusion The maintenance of segmental stability has significant effect in the surgical treatment of spinal tuberculosis. Sta-tus of segmental stability of each patient should be evaluated preoperatively. Satisfactory clinical results can be achieved by proper selection of the surgical procedure according to the status of segmental stability.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2005年第2期74-78,共5页
Chinese Journal of Orthopaedics
