前、后路内固定手术治疗腰椎脊柱结核研究

目的探讨腰椎脊柱结核理想的手术治疗方案。方法回顾总结2008年3月~2010年3月间行病灶清除植骨融合内固定术病例68例。一期行前路病灶清除植骨融合内固定术者30例（A组）,一期行后路内固定前路病灶清除植骨融合术者38例（B组）;每个组又分为累及单个椎体组（A1,B1）及累及多个椎体组（A2,B2）。分别对比研究A1、B1及A2、B2的手术时间、术中出血量、并发症及畸形矫正情况。结果 A1组手术时间、术中出血量明显低于B1组;B2组矫形率、稳定性及并发症发生率优于A2组。结论腰段脊柱结核累及单个椎体时,一期前路病灶清除植骨融合内固定术为优选;累及多个椎体时,一期后路内固定前路病灶清除植骨融合术为优选。

COMPARISON OF ANTERIOR AND POSTERIOR IN TERNAL FIXATION FOR THORACOLUMBAR TUBERCULOSIS

Objective To explore an ideal surgical treatment for abdominal vertebrae tuberculosis.Methods Sixty-eight cases of abdominal vertebrae tuberculosis treated by focus clearance,bone graft fusion and internal fixation from March 2008 to March 2010 were retrospectively studied.All the cases were divided into two groups： 30 cases in group A underwent one-stage anterior focus clearance,bone graft fusion and anterior internal fixation by screw system;and 38 cases in group B underwent one stage posterior internal fixation by screw system,anterior focus clearance and bone graft fusion.The two groups included four subsets： single vertebrae involved（A1,B1）,multi-2-vertebrae involved（A2,B2）.The operation time,bleeding,correction rate,recovery of neurological function and complications were compared between A1 and B1 or between A2 and B2 respectively.Results The bleeding in group A1 was obviously less than those of group B1;Group B2 had more advantages such as in correction rate,stability and complications than group A2.Conclusion When single vertebrae involved,the surgical procedure of one-stage anterior focus clearance,bone graft fusion and anterior internal fixation by screwed system is a better choice for abdominal vertebrae tuberculosis;whereas,the procedure of one-stage posterior internal fixation by screwed system,anterior focus clearance and bone graft fusion is better when multi-2-vertebrae involved.