胸腰椎脊柱结核

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1、短程化疗与植骨内固定治疗胸腰椎脊柱结核常彦海刘军凌鸣范亚一刘时璋李勇祁洁刘宗智摘要：目的探讨胸腰椎脊柱结核短程化疗以及前路和前后路联合手术方式的临床疗效。方法2005～2008年，对38例胸腰椎脊柱结核患者行3月4联抗结核药物强化治疗，3联药物6月持续治疗期；其中前路病灶清除植骨内固定21例，后路椎弓根钉棒系统内固定，前路病灶清除椎间植骨17例。观察结核治愈率、术后神经功能的改善情况及植骨融合情况。结果35例获得随访，时间1.2-3年，平均1.6年。脊柱结核均治愈，无全身及局部并发症，脊髓功能损伤恢复，植骨块愈合，植骨愈合时间4-7月。

2、内固定无松动、断裂。结论短程化疗结合选择前路或前后路联合手术方式治疗脊柱结核，可加强脊柱稳定，改善畸形，利于神经功能恢复和植骨愈合。关键词：脊柱结核；胸腰椎；化疗；脊柱融合术；内固定器Short-coursechemotherapyandbonegraftingwithinternalfixationforthetreatmentofthoracicandlumbarspinaltuberculosis.ChangYan-hai,Liujun,Lingming,etal.（DepartmentofOrthopaedics,ShanxiP

3、rovincialPeople’sHospital,ShaanxiXi,an710068）Abstract:ObjectiveToevaluatetheclinicalefficacyofshort-coursechemotherapyandanterirsurgicalmethodoranterior-posteriormethodforthetreatmentofthoracicandlumbarspinaltuberculosis.MethodsFrom2002～2007,38patientswithspinaltuberculo

4、sisweretreatedwithchemotherapyincluding4kindsmedicinefor3months,andpostoperatively3kindsmedicinewascontinualusedfor6months.One-stagedanteriorlesiondebridement,bonegraftingandinternalfixationwereperformedon21patients,combinedanteriordebridementandbonegraftingwithposterior

5、transpedicularinstrumentationwereperformedon17patients.Theobservedindicesincludedthecureoftuberculosis,bone-healingrateandrecoveryofneurologicalfunction.Results35caseswerefollowed-upforaverage1.6years(from1.2to3years).Spinaltuberculosiscompletelycured.Nosignificantsystem

6、icandlocalcomplicationswerefound.Thepatientwithspinalneurologicaldeficitsrecovered,thegraftedbonefusedcompletely,andthetimewasbetween4～7months.Nolooseandbreakoftheinternalfixationwasfound.ConclusionsFullyshort-coursechemotherapyforspinaltuberculosis,andcombinesanterirsur

7、gicalmethodoranterior-posteriormethod,Itiseffectiveincorrectionofkyphoticdeformity,restorationofspinestability,recoveryofneurologicalfunctionandaccelerationofbonehealing.KeyWord:Spinaltuberculosis；Thoracicandlumbarvertebrae；Chemotherapy；Spinalfusion；Internalfixators骨与关节结

8、核是常见的结核病之一，其中3％～4％的结核感染者涉及到骨骼系统，超过50％的患者影响到脊柱［1］。结核病发病过程一般缓慢，其治疗过程应重视联合、足程、支持的综合性治疗。短程化疗结合病灶清除植骨内固定手术治疗