胸腰椎脊柱结核胸腰脊柱结核.docVIP

短程化疗与植骨内固定治疗胸腰椎脊柱结核 常彦海 刘军 凌鸣 范亚一 刘时璋 李勇 祁洁 刘宗智 摘要：目的 探讨胸腰椎脊柱结核短程化疗以及前路和前后路联合手术方式的临床疗效。方法 2005～2008年，对38例胸腰椎脊柱结核患者行3月4联抗结核药物强化治疗，3联药物6月持续治疗期；其中前路病灶清除植骨内固定21例，后路椎弓根钉棒系统内固定，前路病灶清除椎间植骨17例。观察结核治愈率、术后神经功能的改善情况及植骨融合情况。结果 35例获得随访，时间1.2-3年，平均1.6年。脊柱结核均治愈，无全身及局部并发症，脊髓功能损伤恢复，植骨块愈合，植骨愈合时间4-7月。内固定无松动、断裂。结论 短程化疗结合选择前路或前后路联合手术方式治疗脊柱结核，可加强脊柱稳定，改善畸形，利于神经功能恢复和植骨愈合。 关键词：脊柱结核；胸腰椎；化疗；脊柱融合术；内固定器 Short-course chemotherapy and bone grafting with internal fixation for the treatment of thoracic and lumbar spinal tuberculosis. Chang Yan-hai, Liu jun, Ling ming, et al.（Department of Orthopaedics , Shan xi Provincial People’s Hospital , Shaanxi Xi,an 710068） Abstract: Objective To evaluate the clinical efficacy of short-course chemotherapy and anterir surgical method or anterior-posterior method for the treatment of thoracic and lumbar spinal tuberculosis. Methods From 2002～2007, 38 patients with spinal tuberculosis were treated with chemotherapy including 4 kinds medicine for 3 months,and postoperatively 3 kinds medicine was continual used for 6 months. One-staged anterior lesion debridement, bone grafting and internal fixation were performed on 21 patients, combined anterior debridement and bone grafting with posterior transpedicular instrumentation were performed on 17 patients.The observed indices included the cure of tuberculosis, bone-healing rate and recovery of neurological function. Results 35 cases were followed-up for average 1.6 years (from 1.2 to 3 years). Spinal tuberculosis completely cured. No significant systemic and local complications were found. The patient with spinal neurological deficits recovered,the grafted bone fused completely, and the time was between 4～7 months. No loose and break of the internal fixation was found. Conclusions Fully short-course chemotherapy for spinal tuberculosis,and combines anterir surgical method or anterior-posterior method, It is effective in correction of kyphotic deformity, restoration of spine stability, recovery of neurological