钛网支撑植骨融合加前路钉棒系统内固定治疗胸腰椎结核(1)
【摘要】 目的 探讨一期前路病灶清除钛网支撑植骨融合加内固定治疗胸腰椎结核的临床疗效。方法 回顾性分析2001年2月至2008年3月在本院接受治疗的胸腰椎结核患者21例，男12例，女9例，年龄18~72岁，平均48.5岁。所有患者均采用一期前路病灶清除、钛网支撑植骨融合加前路内固定术，其间观察围手术期并发症，测定融合节段后突角度、椎间平均高度、钛网沉降率及植骨融合情况。结果 全部病例随访20~48个月，平均26个月，除1例出现肋间神经痛，其余20例均无术后并发症。随访期间未发现结核病灶残留或复发，术后融合节段后凸角为(7.0±2.5)°，终末随访时矫正角度丢失(4.1±1.5)°，所有患者终末随访均达到骨性愈合。结论 一期前路病灶清除钛网支撑植骨融合加内固定治疗胸腰椎结核的临床疗效显著，具有重建可靠，减压彻底和复发率低等优点。
【关键词】 胸腰椎结核；病灶清除；钛网植骨；钉棒系统内固定
Operation of latero-anterior internal fixation by nail-stick and titanium mesh and bone graft for treatment of thoracolumbar spinal tuberculosis
, http://www.100md.com
LIU Ya,WANG Zong-liang,CAI Ming,et al.Nanyang City Orthopedic Hospital,Henan 473000,China
【Abstract】 Objective To evaluate the clinical value of the one-stage anterior radical debridement,titanium mesh cages(TMCS) bone fusion and internal fixation for the treatment of thoracolumbar spinal tuberculosis.Methods Twenty-one thoracolumbar spinal tuberculosis cases from February 2001 to March 2008 were analyzed retrospectively,There were 12 males and 9 females,and mean age was 48.5 years old(18 to 72 years old),operative methods including anterior radical debridement、bone fusion with titanium mesh cages combined anterior internal fixation were performed.During this period perioperative complications were observed.Degree of byphosis、intervertebral averaging height、bone fusion and TMCS subsidence pre and postoperatively were determined.Results All the patients were followed up for 20 to 48 months postopratively,with the average of 26 months.In addition to the emergence of 1 cage of intercostals neuralgia,the remaining 20 patients had no postoperative complications.During the follow-up found no residual or recurrent lesions of tuberculosis.The postoperative kyphosis angle was (7.0±2.5)°,the loss angle of kyphosis correction was(4.1±1.5)°,All patients reached the end follow-up bone healing.Conclusion The significant curative effect of one-stage anterior radical debridement,titanium mesh cages bone fusion and internal fixation for the treatment of thoracolumbar spinal tuberculosis,The procedure allows satisfactive correction of kyphosis,complete decomperation and lower recurrence.
, 百拇医药
【Key words】
Thoraco-lumbar spinal tuberculosis; Radical debridement; Titanium mesh cages bone fusion; Internal fixation by nail-stick system
脊柱结核因椎体及相邻椎间盘的破坏而导致破坏节段的稳定性丧失，失稳椎体及坏死物质压迫邻近脊髓及神经，患者就诊时往往已出现不全截瘫，大小便功能障碍等脊髓损伤的表现，由于病灶的存在，传统的保守治疗往往不能达到有效的治疗目的，对于手术治疗，因手术内固定物的存在会增加感染等并发症的机会，故对是否使用一直存在争议，随着脊柱外科技术的发展，国内外同道已逐步认识到不行内固定往往难以纠正后凸畸形及重建稳定性，且内固定物的存在不会增加感染的机会[1-3]，故在病灶清除基础上重建脊柱稳定性是手术治疗的关键已逐步成为人们的共识。我科在临床上自2001年2月至2008年3月在一期前路病灶清除的基础上，采用椎体间钛网植骨并前路钉棒内固定治疗胸、腰椎结核，取得满意疗效，现报告如下。
, 百拇医药
1 资料与方法
1.1 一般资料 本组21例，男12例，女9例，年龄18~72岁，平均48.5岁，病程17 d~15年，所以患者均有不同程度发热、消瘦等结核中毒症状及局部疼痛症状，均无严重骨质疏松和急性期化脓性感染。术前X线、CT、MRI明确病变部位:胸椎8例，腰椎6例，胸腰段7例，术前ASIA神经功能分级：A 1例，B 2例，C 7例，D 6例，E 5例。所有病例椎体均有不同程度破坏、塌陷、后凸畸形、椎间隙变窄或消失或伴有椎旁脓肿，有16例累及椎管压迫脊髓。
1.2 术前准备 患者均卧平板床休息制动，常规做痰液、尿液及大便涂片抗酸染色及摄胸片，排除活动性结核和消化道结核，加强营养支持治疗，纠正低蛋白血症、贫血和营养不良。常规化疗3~4周，常规检查肝肾功、血常规、红细胞沉降率、血糖，抗痨过程中每周复查一次肝肾功及红细胞沉降率。
, 百拇医药(刘 雅 王宗亮 蔡 明 白金广 罗良雨 王 敏 陆 兵 王 )
【关键词】 胸腰椎结核；病灶清除；钛网植骨；钉棒系统内固定
Operation of latero-anterior internal fixation by nail-stick and titanium mesh and bone graft for treatment of thoracolumbar spinal tuberculosis
, http://www.100md.com
LIU Ya,WANG Zong-liang,CAI Ming,et al.Nanyang City Orthopedic Hospital,Henan 473000,China
【Abstract】 Objective To evaluate the clinical value of the one-stage anterior radical debridement,titanium mesh cages(TMCS) bone fusion and internal fixation for the treatment of thoracolumbar spinal tuberculosis.Methods Twenty-one thoracolumbar spinal tuberculosis cases from February 2001 to March 2008 were analyzed retrospectively,There were 12 males and 9 females,and mean age was 48.5 years old(18 to 72 years old),operative methods including anterior radical debridement、bone fusion with titanium mesh cages combined anterior internal fixation were performed.During this period perioperative complications were observed.Degree of byphosis、intervertebral averaging height、bone fusion and TMCS subsidence pre and postoperatively were determined.Results All the patients were followed up for 20 to 48 months postopratively,with the average of 26 months.In addition to the emergence of 1 cage of intercostals neuralgia,the remaining 20 patients had no postoperative complications.During the follow-up found no residual or recurrent lesions of tuberculosis.The postoperative kyphosis angle was (7.0±2.5)°,the loss angle of kyphosis correction was(4.1±1.5)°,All patients reached the end follow-up bone healing.Conclusion The significant curative effect of one-stage anterior radical debridement,titanium mesh cages bone fusion and internal fixation for the treatment of thoracolumbar spinal tuberculosis,The procedure allows satisfactive correction of kyphosis,complete decomperation and lower recurrence.
, 百拇医药
【Key words】
Thoraco-lumbar spinal tuberculosis; Radical debridement; Titanium mesh cages bone fusion; Internal fixation by nail-stick system
脊柱结核因椎体及相邻椎间盘的破坏而导致破坏节段的稳定性丧失，失稳椎体及坏死物质压迫邻近脊髓及神经，患者就诊时往往已出现不全截瘫，大小便功能障碍等脊髓损伤的表现，由于病灶的存在，传统的保守治疗往往不能达到有效的治疗目的，对于手术治疗，因手术内固定物的存在会增加感染等并发症的机会，故对是否使用一直存在争议，随着脊柱外科技术的发展，国内外同道已逐步认识到不行内固定往往难以纠正后凸畸形及重建稳定性，且内固定物的存在不会增加感染的机会[1-3]，故在病灶清除基础上重建脊柱稳定性是手术治疗的关键已逐步成为人们的共识。我科在临床上自2001年2月至2008年3月在一期前路病灶清除的基础上，采用椎体间钛网植骨并前路钉棒内固定治疗胸、腰椎结核，取得满意疗效，现报告如下。
, 百拇医药
1 资料与方法
1.1 一般资料 本组21例，男12例，女9例，年龄18~72岁，平均48.5岁，病程17 d~15年，所以患者均有不同程度发热、消瘦等结核中毒症状及局部疼痛症状，均无严重骨质疏松和急性期化脓性感染。术前X线、CT、MRI明确病变部位:胸椎8例，腰椎6例，胸腰段7例，术前ASIA神经功能分级：A 1例，B 2例，C 7例，D 6例，E 5例。所有病例椎体均有不同程度破坏、塌陷、后凸畸形、椎间隙变窄或消失或伴有椎旁脓肿，有16例累及椎管压迫脊髓。
1.2 术前准备 患者均卧平板床休息制动，常规做痰液、尿液及大便涂片抗酸染色及摄胸片，排除活动性结核和消化道结核，加强营养支持治疗，纠正低蛋白血症、贫血和营养不良。常规化疗3~4周，常规检查肝肾功、血常规、红细胞沉降率、血糖，抗痨过程中每周复查一次肝肾功及红细胞沉降率。
, 百拇医药(刘 雅 王宗亮 蔡 明 白金广 罗良雨 王 敏 陆 兵 王 )