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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