张宏其;唐明星;王昱翔;郭超峰;吴建煌;刘金洋;刘少华;邓盎;高琪乐;

• 1:中南大学湘雅医院脊柱外科湘雅脊柱外科中心

摘要(Abstract)：

[目的]探讨椎体间多枚分网的异形钛网植骨技术应用于单纯一期后路手术治疗脊柱结核的可行性及疗效。[方法]自2008年7月~2010年6月,采用单纯一期后路多枚分网的异形钛网植骨新技术治疗的脊柱结核患者共48例,男27例,女21例;年龄16~78岁,平均(41.2±7.8)岁;其中胸段21例,胸腰段14例,腰段9例,腰骶段4例。ASIA分级:A级1例,B级9例,C级17例,D级10例,E级11例。术前血沉18~106 mm,平均(46.7±10.6)mm。胸腰椎结核后凸角度4°~62°,平均(26.6±9.2)°,腰骶段结核的腰骶角15°~31°,平均(23.5±5.7)°。所有患者术后继续抗痨治疗12~18个月。[结果]手术时间为90~180 min,平均(128±24)min,术中失血量100~800 ml,平均(310±125)ml。术后随访18~57个月,平均(37±8)个月。1例患者出现脑脊液漏,3例患者伤口延迟愈合。无窦道形成,无感染性脑脊髓膜炎发生,无结核复发,无钛网沉降。所有患者神经功能均有不同程度改善;术后6个月血沉均恢复正常;终末随访时胸腰椎后凸角度0°~18°,平均(7.2±2.2)°,腰骶段结核的腰骶角为23.8°~35.3°,平均(30.6±6.3)°,随访过程中无明显角度丢失;植骨融合时间为4~8个月,平均6个月。[结论]对于病灶较局限的脊柱结核,采用单纯一期后路多枚分网异形钛网植骨技术能达到满意的治疗效果。

关键词(KeyWords)： 异形钛网;多枚分网技术;脊柱结核;椎体间植骨;单纯后路

Abstract:

Keywords:

基金项目(Foundation): 湖南省科技厅科技计划一般项目资助(项目编号:2009JT4011);湖南省科技厅科技计划重点项目(项目编号:05SK2004);; 湖南省“芙蓉学者项目”

作者(Author): 张宏其;唐明星;王昱翔;郭超峰;吴建煌;刘金洋;刘少华;邓盎;高琪乐;

Email:

DOI:

参考文献(References)：

• [1]Zhang HQ,Li JS,Zhao SS,et al.Surgical management for thoracic spinal tuberculosis in the elderly:posterior only versus combined posterior and anterior approaches[J].Arch Orthop Trauma Surg,2012,12:1717-1723.
• [2]Zhang HQ,Sheng B,Tang MX,et al.One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation,debridement,and combined interbody and posterior fusion via posterior-only approach[J].Eur Spine J,2013,3:616-623.
• [3]Zhang HQ,Lin MZ,Ge L,et al.Surgical management by onestage posterior transforaminal lumbar debridement,interbody fusion,and posterior instrumentation for lumbo-sacral tuberculosis in the aged[J].Arch Orthop Trauma Surg,2012,12:1677-1683.
• [4]Zhang HQ,Wang YX,Guo CF,et al.One-stage posterior approach and combined interbody and posterior fusion for thoracolumbar spinal tuberculosis with kyphosis in children[J].Orthopedics,2010,11:808.
• [5]张宏其,郭虎兵,陈筱,等.单纯一期后路病灶清除椎体间植骨融合内固定治疗胸椎结核的临床研究[J].中国矫形外科杂志,2012,1:34-40.
• [6]Lee CK,Vessa P,Lee JK.Chronic disabling low back pain syndrome caused by internal disc derangements.The results of disc excision and posterior lumbar interbody fusion[J].Spine,1995,20:356-361.
• [7]Garg B,Kandwal P,Nagaraja UB,et al.Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis:a retrospective analysis[J].Indian J Orthop,2012,2:165-170.
• [8]Pola E,Rossi B,Nasto LA,et al.Surgical treatment of tuberculous spondylodiscitis[J].Eur Rev Med Pharmacol Sci,2012,2:79-85.
• [9]Ma YZ,Cui X,Li HW,et al.Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults[J].Int Orthop,2012,2:299
• [10]He Q,Xu J.Comparison between the antero-posterior and anterior approaches for treating L5S1vertebral tuberculosis[J].Int Orthop,2012,2:345-351.