脊柱结核治疗

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1、一期病灶清除植骨内固定术治疗脊柱结核厉晓龙，　王生介，　刘俊，　杨雷，　陆贝晨（江苏大学附属常州武进人民医院骨科　213000）摘要：[目的]讨论手术治疗脊柱结核的有效性和安全性，探讨病变椎体部分切除、植骨融合、内固定治疗脊柱结核的临床效果。[方法]　回顾性分析35例脊柱结核患者，在2003年１月～2008年1月采用前路病变椎体部分切除、植骨融合、前路或后路内固定手术治疗，其中颈椎结核2例，胸椎结核18例，腰椎结核15例，前路固定26例，后路固定9例。所有病例随访12～24个月，平均18个月。[结果]　所有患

2、者术后切口均一期愈合，早期无局部窦道形成。2例术后3个月结核窦道形成行二次翻修外，余患者结核症状均消失，病灶全部愈合，无复发。椎体间植骨5个月融合，12例术前有神经损伤症状者Frankel分级平均提高1.5级，15例后凸畸形术后平均矫正23°。[结论]：一期病灶清除、植骨融合、前路（后路）内固定治疗脊柱结核可重建脊柱稳定性、缩短卧床时间，纠正和预防后凸畸形，是治疗脊柱结核的理想方法。关键词：脊柱结核；　病灶清除；　　内固定　　One-stagedebridementandintervertebralfusio

3、nwithinstrumentationinthetreatmentofspinaltuberculosisLIxiaolong,WANGshengjie,etal.DepartmentofOrthopaedics,Changzhou,WujinHospital,JiangsuUniversity,Changzhou213000,ChinaAbstract:[object]Todiscusstheeffectivityandsafetyinthetreatmentofspinaltuberculosis,ex

4、ploretheclinicalsignificancewithpartialvertebretomy,graftingboneandinternalfixation.[Methods]Dataof35patientswithspinaltuberculosisundergongtheoperationofdebridementandgraftingboneandanteriororposteriorinternalfixtionbetweenJanuary2003toJanuary2008weredocum

5、entedretrospectively.2patientswithcervical,18patientswiththoracicand15patientswithlumberspinaltuberculosis,26patientsviaanteriorapproach,9patientsviaposteriorapproach.Allpatientswerefollowedupfor12～24months,average18months.ResultsAllthesepatientshadtheirinc

6、isionhealedbyfirstintentionwithoutsinusformation.Recurrencewerefoundin2casesafterfirstsurgeryin3monthsandperformedsecondoperation,theother’stoxicsymptomoftuberculosisalleviatedgreatly,theirfocuswaseliminatedcompletely,norecurrence.Interbodyfusionfused5month

7、slater,12caseswithneurologicaldeficitshadanimprovementofneurologicalfunctionpostoperatively,thetechniqueFrankelaverageimprove1.5grades,15caseswithKyphosisdeformitywascorrectedmean23°.ConclusionsOne-stagedebridementandgraftingandanteriororposteriorinternalfi

8、xationwithinstrumentationinthetreatmentofspinaltuberculosiscanreconstructthespinalcolumnstability,shortenthetimelieinbed,correctandpreventKyphosisdeformity,thecurativeeffectisaccurate.Keywords:spinaltu