摘要
目的:观察前路一期病变椎体切除、人工椎体或钛网融合器植骨替代、椎体钉板或钉棒系统内固定治疗连续两个及以上节段胸腰椎结核并后凸畸形的疗效。方法:34例病变累及连续两个及两个以上椎节的胸腰椎结核患者,术前后凸Cobb角27.8°￣65.4°(38.6°±10.3°),一期行前路病变椎体切除,椎间撬拔撑开复位,人工椎体或钛网融合器植骨替代,辅以椎体钉板或钉棒系统短节段邻近椎节内固定,重建脊柱稳定性,术后均给予短疗程化疗。观察术后局部疼痛缓解、脊髓神经功能恢复、后凸畸形矫正及脊柱稳定性情况。结果:患者术后局部疼痛缓解,术前伴有脊髓神经损伤的12例患者术后神经功能均有不同程度恢复。影像学检查示脊柱内固定物位置良好,椎体序列恢复良好,椎间高度恢复。后凸Cobb角矫正至2.1°￣14.2°(7.5°±8.3°),平均矫正31.2°±8.5°。随访18￣54个月,平均35个月。末次随访时后凸矫正度丢失4.3°±3.8°,均无结核复发。结论:连续两个及两个以上节段的胸腰椎结核采用前路一期行病变椎体切除有利于病灶彻底清除,减少复发;也有利于椎管彻底减压。前路椎体替代、植骨内固定重建脊柱稳定性可更好地纠正和预防脊柱后凸畸形。
Objective：To observe the clinical results of one-stage vertebral body resection and reconstruction with artificial vertebral body or titanium cage in treating muhi-segmental thoracolumbar spinal tuberculosis kypbosis.Method：34 cases of tboracolumbar spinal tuberculosis of multi-level involvement,with Cobb angle of kypbosis of 27.8°-65.4°mean,38.6°±10.3° ）,were treated by one-stage of vertebral resection and reconstruction with artificial vertebral body or titanium cage.Short-course anti-tuberculosis chemotherapy was used postoperatively in all patients.Relief of the pain,the neurological function,kypbosis correction and spinal stability were evaluated.Result：All patients were followed-up for 18 months to 54 months with a mean period of 35 months.No neurological deficit and wound infection were noted.All patients experienced significant pain relief, and 12 patients showed improved neurological status（at least one grade of improvement on Frankel＇s functional classification）.Tbe instrument provided immediate stability and protected against progression of kypbotic deformity in all patients.Postoperative radiological evaluation revealed no evidence of implant failure and disc height loss.Solid bony fusion was evidenced in all patients.The postoperative kypbotic Cobb angle was 2.1°～14.2°（the mean value of 7.5°±8.3°）,with the average correction rate of 31.2°±8.5°,the loss of correction at final follow-up was 4.3°±3.8°.Conclusion：One-stage of vertebral resection and reconstruction is effective in treating tboracolumbar spinal tuberculosis which involved more than two segments.Vertebral resection followed by radical debridement can decrease the rate of recurrence.Vertebral replacement and anterior instrumentation is found helpful in securing early fusion and kypbosis correction.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2006年第3期208-211,共4页
Chinese Journal of Spine and Spinal Cord
