任忠明;张远;张翊;吴宏飞;张玉良;舒亮;

• 1:武警浙江省总队医院脊柱外科武警骨科医学专科中心

摘要(Abstract)：

[目的]探讨胸腰椎结核前路手术病灶清除的必要性及内置物固定的重要性。[方法]2008年3月~2012年12月,对72例胸腰椎结核患者行一期前路病灶清除植骨联合前路或后路内固定重建治疗,其中男34例,女38例;年龄23~76岁,平均31.9岁;病程4~28个月,平均11.7个月;胸椎21例,胸腰段30例,腰椎19例,腰骶段2例;累及4个椎体3例,3个椎体11例,2个椎体27例,1个椎体31例;其中42例显示干酪样坏死组织或死骨侵犯相应椎管,35例伴椎旁脓肿或腰大肌脓肿,26例合并病变区域不同程度的后突畸形。按Frankel脊髓损伤程度分级:B级2例,C级7例,D级36例,E级27例。术前至少2周以上正规四联抗结核药物治疗,根据个化性方案分别对患者行病灶彻底清除、植骨内植物固定手术,药物化疗的总疗程时间为12~18个月。[结果]本组病例经12个月以上随访,平均16.7个月。其中3例术后复发再次切开引流、病灶清除或穿刺置管引流灌冲,最终痊愈;2例术后出现肋间神经痛,2例出现股神经牵拉痛,3例出现取髂骨区疼痛,经对症治疗后均得到缓解。所有病例末次随访时中毒症状均消失,按Frankel脊髓损伤程度评分标准:B级1例,C级2例,D级8例,E级61例;影像学检查未发现内置物松动、断裂,植骨区见骨性融合,临床疗效满意。[结论]一期前路病灶清除植骨联合前路或后路内固定重建术,能彻底清除病灶,有效矫正脊柱畸形和重建脊柱稳定,促进植骨区骨融合和椎体结核愈合。

关键词(KeyWords)： 脊柱结核;病灶清除术;植骨;内固定

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 任忠明;张远;张翊;吴宏飞;张玉良;舒亮;

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参考文献(References)：

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