前路病灶清除椎体间植骨内固定治疗脊柱结核

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1、前路病灶清除椎体间植骨内固定治疗脊柱结核［摘要］目的：探讨前路病灶清除椎体间植骨内固定治疗脊柱结核的临床效果及存在问题。方法：1996年1月〜2005年12月，对78例脊柱结核患者行前路病灶切除椎体间植骨内固定治疗。术前行异胭腓、利福平、毗嗪酰胺、左氧氟沙星等抗结核治疗，平均2〜4周，术后继续常规抗结核治疗2年左右。结果：随访70例，随访时间24〜38个月，优38例，良25例，一般7例。椎体间植骨3〜6个月融合，平均4个月。30例合并截瘫患者术前Frankel分级A级5例，B级10例，C级11例，D级4例，E级0例，术后：A级3例,B级3例，C级2例，D级11例，E级11例，术前脊柱后凸

2、(38.80±3.50)°,术后(12.30±2.40)°,均有显著改善(PV0.05)。结论：前路病灶清除椎体间植骨内固定治疗脊柱结核，既能彻底切除病灶防止复发，重建脊柱稳定性，恢复脊柱支撑功能，又能提高植骨融合率，矫正和预防后凸畸形，防止晚发神经损害。［关键词］脊柱结核；前路病灶清除；内固定［中图分类号JR681E文献标识码］A［文章编号］1673-7210(2008)04(a)-063-02AnteriordebridementandintervertebralfusionwithinstrumentationinthetreatmentofspinaltuberculosisQI

3、UXiao-pingl,LINLi-jun2(1.The2edSurgicalDepartment,LianchengCountyHospital,FujianProvince,Liancheng366200,China；2.TheOrthopedicsDepartment,ZhujiangHospitalofNanfangMedicalVniversity,Guangzhou510282,China)[Abstract]Objective：TodiscusstheeffectinthetreatmentofspinaltuberculosisAnteriordebridementand

4、intervertebralfusionwithinstrumentation.Methods：BetweenJan1996andDec2005,78patientswithspinaltuberculosisweretreatedwithanteriordebridementandintervertebralfusionwithinstrumenta/tion.Treatingtuberculosisfor2〜4weeksbeforeoperation.ResuIts：Allpatientswerevisitedregularlyafteroperationfor24~38months

5、,about29monthsinavarage・theirfocuswaseliminatedcomplatdy,thecutbecamehealedforthefirsestage,anteriorinterbodyfusionfused4monthslater.Thefunctionofparaplegiapre-operativewere(Frankelcriteria):A5cases,BlOcases,C11cases,D4casesandE0casewhilethatofthepost-operativewere：A3cases,B3cases,C2cases,D11case

6、sandE11cases・Theaveragekyphosispre-operativewere38.80±3・50degreeswhilethatofpost-operativewere12.30+2.40degrees.Therewasasignificantdifference(P<0.05).Conclusion:Anteriordebridementandintervertebralfusionwithinstrumentationinthetreatmentofspinaltuberculosiscancuretuberculosiswithoutrecurrenceandc

7、analsocorrectdeformity,strengthenthespinalstructuretopreventsecondaryparaplegia,correctingthekyphosisandpreventingprogressionofkyphsis.[Keywords]Spinaltuberculosis；Anteriordebridement；Internalfixation脊柱结核的发病率正呈增加的趋势，传统