脊柱结核的治疗

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1、一期病灶清除植骨内I古I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、植佇融合、内固定治疗脊林结核的临床效果。［方法］回顾性分析35例脊柱结核患者，在2003年1月〜2008年1月釆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。所冇病例随访12〜24个月，平均18个月。［结果］所有患者术后

2、切口均一期愈合，早期无局部窦道形成。2例术示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个刀融合，12例术前冇神经损伤症状者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-stagedebridementandintervertebralfusionwithi

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

4、etheclinicalsignificancewithpartialvertebretomy,graftingboneandinternalfixation.［Methods］Dataof35patientswithspinaltuberculosisundergongtheoperationofdebridementandgraftingboneandanteriororposteriorinternalfixtionbetweenJanuary2003toJanuary2008weredocumen

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

6、isionhealedbyfirstintentionwithoutsinusformation.Recurrencewerefoundin2casesafterfirstsurgeryin3monthsandperformedsecondoperation,theother'stoxicsymptomoftuberculosisalleviatedgreatly,theirfocuswaseliminatedcompletely,norecurrence.Interbodyfusionfused5mon

7、thslater,12caseswithneurologicaldeficitshadanimprovementofneurologicalfunctionpostopcrativcly,thetechniqueFrankelaverageimprove1.5grades,15caseswithKyphosisdeformitywascorrectedmean23°.ConclusionsOne-stagedebridementandgraftingandanteriororposteriorintern

8、alfixationwithinstrumentationinthetreatmentofspinaltuberculosiscanreconstructthespinalcolumnstability,shortenthetimelieinbed,correctandpreventKyphosisdeformity,thecurativeeffectisaccurate・Keywords:spinaltuberculosis