临床骨科杂志2017，Vol.20Issue(6)：641-644,4.DOI:10.3969/j.issn.1008-0287.2017.06.001
一期侧前方入路病灶清除植骨双钉棒系统内固定治疗胸腰椎脊柱结核
Treatment of thoracic and lumbar spinal tuberculosis via anterolateral approach with one-stage focus debridement and bone grafting with double screw-rods internal fixation system
摘要
Abstract
Objective To investigate the clinical effect of one-stage focus debridement via anterolateral approach , autologous iliac grafting and internal fixation with double pedicle screws system in the treatment of thoracic and lumbar spinal tuberculosis.Methods The 35 cases of thoracic and lumbar spinal tuberculosis were routinely received antitubercular drugs for 2~3 weeks before operation.After the improvement of the overall condition , one-stage anterior focus debridement , autologous iliac grafting fusion and internal fixation with double nail were used via anterior approach.After operation,they were systematically and routinely treated with antitubercular drugs for 12~18 months.The operation time ,intraoperative blood loss ,complications ,bone fusion were recorded.The preoperative , 3 months after operation, last follow-up,visual analogue scale(VAS),Coronary Cobb angles,ESR and CRP were analyzed.The improvement of ASIA classification of spinal nerve function was recorded at the last follow-up.Results Operation time was 120~225 min,and the intraoperative blood loss was 450~1060 ml.No severe complications were observed during operation and after the operations.All patients were followed up for 12~22 months.The lesions removed during operation were proceeded by pathological examination and conformed to tuberculosis.The symptoms of tuberculosis were eliminated,ESR and CRP returned to normal at the last follow-up.The bone graft fusion time was 8~12 months.There were no complications such as shift , loosening or breaking of the implants during the follow-up period.One case of ASIA grade B recovered to grade C ,4 grade C recovered to grade D in 3 cases, and grade E in 1 case,18 cases grade D recovered to grade E.Conclusions On the basis of the effective ,systemic and routine antituberculosis treatment ,the surgical treatment of thoracic and lumbar spinal tuberculosis with one-stage anterior debridement , autologous iliac grafting and double screw-rods internal fixation are effective.It is beneficial to the recovery of neural function , correction of kyphosis and restoration of biomechanical stability of the spine.关键词
胸腰椎结核/侧前路入路/植骨/内固定/脊柱融合Key words
thoracic and lumbar spinal tuberculosis/anterolateral approach/bone graft/internal fixation/spinal fusion分类
医药卫生引用本文复制引用
聂治军,白静静,张银刚,徐洪海,常彦海,李全义..一期侧前方入路病灶清除植骨双钉棒系统内固定治疗胸腰椎脊柱结核[J].临床骨科杂志,2017,20(6):641-644,4.基金项目
国家自然科学基金项目(编号:81371987) （编号:81371987）
