目的 回顾性总结研究采用经前路一期病灶清除、钛笼植骨结合内固定方法治疗脊柱胸腰段结核的效果。方法 胸腰段脊柱结核患者21例,术前经标准抗结核方案治疗后,采用经前路一期病灶清除、钛网植骨结合内固定的术式治疗,术后继续抗结核治疗、营养支持、适当功能锻炼。定期随访观察患者术后各项指标(神经症状、并发症)的恢复情况等。结果 经过平均19个月随访,21例患者脊柱结核均被治愈,无全身及局部复发,且术后疼痛消失,畸形明显纠正,内固定物无松动,植骨融合好,神经症状明显缓解,未见明显手术并发症。结论 经前路一期病灶清除钛笼植骨结合内固定是治疗胸腰段结核的安全、有效的方法。
Abstract
Objective To study the effect of one stage, anterior debridement, titanium cage fusion with bone grafting combined with internal fixation in treating thoracolumbar spinal tuberculosis. Methods All the 21 patients with thoracolumbar spinal tuberculosis were treated by standard anti-tuberculosis therapy before operation. Then one stage, anterior debridement, titanium cage fusion with bone grafting combined with internal fixation was implemented, anti-tuberculosis treatment and functional exercise were continued. Postoperative lumbar back pain degree, recovery, neurological symptoms, complications in all patients were observed. Results After an average of 19 months follow-up,21 patients with spinal tuberculosis were cured, no systemic and local recurrence, back pain disappears, spinal deformity corrected effectively, no loosening of internal fixation, bone graft fused well, neurologic symptoms eased significantly, and no obvious complications. Conclusions Anterior debridement, titanium cage fusion with bone grafting combined with internal fixation for primary surgical management is an effective and safe method in treating thoracolumbar spinal tuberculosis.
关键词
脊柱结核 /
钛笼 /
内固定
Key words
spinal tuberculosis /
titanium cage /
internal fixation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 许建中. 脊柱结核治疗中的几个重要问题[J].武警医学,2007,18(3):217-218.
[2] Peng L, Ming W S, Shi J L, et al. A retrospective controlled study of three different operative approaches for the treatment of thoracic and lumbar spinal tuberculosis: Three years of follow-up[J]. Clinical Neurology and Neurosurgery, 2015, 128:25-34.
[3] Soares D,Brito J, Tirado A, et al.Surgical treatment of spinal tuberculosis complicated with extensive abscess[J].Iowa Orthop J,2014,34:129-136.
[4] 邵川强,王文己.脊柱结核外科治疗进展[J].中国矫形外科杂志,2012,20(3):245-247.
[5] Tuli S M. Tuberculosis of the spine:a historical review[J]. Clin Orthop Relat Res,2007,460:29-38.
[6] Benli I T,Kaya A,Acaroglu E. Anterior instrumentation in tuberculous spondylitis:is it effective and safe[J]. Clin Orthop Relat Res,2007,460:108-116.
[7] 马远征.脊柱结核的治疗原则及相关问题[J].中国骨伤,2010,7,23(7):483-484.
[8] Pola E, Rossi B, Nasto L A, et al.Surgical treatment of tuberculous spondylodiscitis[J].Eur Rev Med Pharmacol Sci,2012, 16 (Suppl 2):79-85.
[9] Li J, Li X L, Zhou X G, et al.Surgical treatment for spinal tuberculosis with bilateral paraspinal abscess or bilateral psoas abscess: one-stage surgery[J].J Spinal Disord Tech, 2014,27(8):E309-314.
[10] 马远征,薛海滨.脊柱结核的外科治疗策略[J].中国脊柱脊髓杂志,2009,19(11):805-807.
[11] Xu C, Yuan Z M, Xing C, et al. Outcomes of Different Surgical Procedures in the Treatment of Spinal Tuberculosis in Adults[J]. Medical Principles and Practice, 2013,22:346-350.
[12] 赵 敏,张 立,许建中,等.一期后路病灶清除、椎体间钛笼植骨椎弓根钉内固定治疗胸椎结核[J].临床骨科杂志,2012,15(3):251-255.
[13] 王 飞,倪 斌,刘 军.经前路一期病灶清除钛网植骨内固定术治疗胸椎及胸腰段结核[J].中国脊柱脊髓杂志,2010,20(5):390-394.
[14] Oga M ,Arizono T, Takasita M ,et al. Evaluation of the risk of instrumentation as aforeign body in spinaltuberculosis[J].Spine,1993, 18:1890-1894.
[15] Yilmaz C, Selek H Y.Anetrior instrumentation for the treatment of spinal tuberculosis[J].J Bone Joint Surg (AM),1999,81: 1261-1267.
[16] 王文军,周江南,曹盛俊,等.钛网在胸腰段脊柱前路重建术中应用的生物力学评价[J].中华创伤杂志,2003,19(1):31-33.
基金
武警后勤学院附属医院种子基金(FYQ201456)
PDF(4489 KB)
