摘要
Abstract
Objective To analyze clinical efficacy of treatment for lower cervical tuberculosis via one-stage anterior debridement,iliac bone autograft fusion and internal fixation.Methods Twenty-two cases with lower cervical tuberculosis admitted in the Department of Orthopedics,Chongqing Three Gorges Central Hospital from July 2011 to December 2014 were analyzed retrospectively.The lesion involved 2 vertebral bodies in 14 cases and 3 vertebral bodies in 8 cases.All cases were treated with one-stage anterior debridement and iliac bone graft fusion with titanium plate internal fixation.Four first-line antituberculous drugs(isoniazid,rifampicin,pyrazinamide and ethambutol)were given for 2 weeks before operation and for 12 to 18 months after operation.Patients were followed up to observe the improvement of clinical symptoms,bone graft fusion,lower cervical kyphosis Cobb angle,visual analogue score,erythrocyte sedimentation rate,C reactive protein,wound healing and neurological function improvement.Results The average follow-up time was (20.36± 1.86) months ranged from 18 to 24 months.The clinical symptoms were improved obviously,and the bone grafts were completely fused with the average fusion time (3.32±0.72) months ranged from 2 to 4 months in all patients.The lower cervical kyphosis Cobb angle ((4.86± 1.78)°),visual analogue score ((1.59±1.05) score),erythrocyte sedimentation rate ((7.1±2.6) mm/1 h) and C reactive protein ((4.8±2.4) mg/L) at last follow up time were significant lower than those ((23.09 ± 4.34)°),((6.77±1.26) score),((42.6±11.5) mm/1 h) and ((45.2±9.4) mg/L) before operation with significant difference statistically(t was 19.69,16.20,14.69,and 20.60,respectively,P＜0.01).There were no serious complications including no internal fixation loosening,shedding,broken off,and tuberculosis recurrence in 22 cases.All incisions were healed by first intention without infection and sinus formation.The preoperative Frankel level of nerve function was grade B in 3 cases,grade C in 6 cases,grade D in 8 cases and grade E in 5 cases and nerve function was recovered to grade D in 2 cases(grade B in all cases before operation),grade E in 20 cases.Conclusion Tuberculous lesions complete clearance with anterior debridement,anterior decompression,iliac bone graft fusion and internal fixation combined with four first line antituberculous drugs can reconstruct cervical stability and obtain good clinical efficacy.关键词
颈椎/结核,脊柱/外科手术/骨移植/内固定器/治疗结果Key words
Cervical vertebrae/Tuberculosis, spinal/Surgical procedures, operative/Bone transplantation/Internal fixators/Treatment outcome
