后路内固定在脊柱结核中的应用

目的：探讨后路内固定治疗脊柱结核的必要性及适应证。方法：2002年1月-2008年12月采用后路器械固定、融合结合前路彻底病灶清除、植骨治疗脊柱结核17例。病变位于胸椎3例,胸腰段2例,腰椎4例,腰骶椎8例;累及2个节段7例,3个节段7例,4个节段3例;有3例伴窦道形成;9例伴不同程度的脊髓和（或）神经根受压症状;术前后凸成角10°-72°,平均31°。所有患者均一期手术。结果：术后随访6个月-5年,平均3.1年,术后切口均Ⅰ期愈合,后凸成角7°-58°,平均16°,椎间植骨平均在5个月融合,植骨融合率95.6%,优良率达89.6%,无一例复发。结论：后路器械固定结合前路彻底病灶清除、植骨治疗脊柱结核主要适用于多个节段受累、腰骶段及伴窦道者,利于恢复脊柱的稳定性、提高植骨融合率、纠正和预防后凸畸形。

Posterioi Fixation and Fusion for Treatment of Tuberculosis of Spine

Objective： To explore the necessity and indication of the posterior instrumentation in the treatment of Spinal tuberculosis. Methods： Seventeen cases of the tuberculosis of thoracic, lumbar and sacral spine were treated with combined anterior （radical debridement and autograft） and posterior （instrumentation and fusion） surgeries in one stage. The lesion were located at thoracic spine in 3 patients, at thoracolumbar spine in 2 patients, at lumbar spine in 4 patients and at lumbosacral spine in 8 patients. The involved veterbral bodies were at 2 segments in 7 patients, at 3 segments in 7 patients and at 4 segments in 3 patients. The preoperative kyphosis was 10-72 degrees with mean of 31 degrees. Sinus was associated in 3 patients and 9 patients had neurologic dificit. Results： The average followed-up period was 3.1 years. All incisions were healed up primarily. Spinal fusion were achieved in 95.6% of the patients within average 5 months after operation. The postoperative hypnosis was 7-58 degrees with mean of 16 degrees. 89.6% of the patients had good results and there was no recurrence within follow-up period. Conclusion： Spinal tuberculosis treated with this surgical technique can achieve a high satisfactory rate with restoring the spinal stability, arresting the disease early, providing early fusion, correcting the hypnosis and preventing progression of hypnosis particularly if more than two vertebral bodies are involved, associated with sinus and lumbosaeral spine tuberculosis.