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一期前后路手术治疗合并严重后凸畸形的胸腰椎活动性结核

One-stage combined anterior and posterior strategy in treating active tuberculosis of thoracic and lumbar spine complicated with severe kyphotic deformity

摘要:

目的 探讨合并严重后凸畸形(后凸角度≥45.)的活动性胸腰椎结核的合理治疗方案.方法 回顾性分析2004年1月至2008年1月治疗的30例合并严重后凸畸形的活动性胸腰椎结核患者的临床资料.其中男性8例,女性22例,年龄7~60岁(平均35岁),病程3~18个月(平均8个月).后凸角度45°~70°(平均58°).30例均有较大的椎旁脓肿,28例合并椎管内脓肿,10例合并不完全性截瘫(Frankel 分级B级2例、C级6例、D级2例).HREZ 方案化疗至少2周后手术治疗,先行后路多节段椎弓根螺钉植入(6~10枚),通过钉棒连接产生提拉力使后凸矫正;再经前入路清除脓肿、部分或全部切除病变椎体,行支撑性植骨重建.术后化疗方案为6HREZ/6~12HRE.对所有病例的后凸角度、术后矫正效果和神经功能恢复程度进行比较分析,同时观察患者的红细胞沉降率和植骨融合情况.结果 手术时间4~6 h(平均5.2 h),出血量600~900 ml(平均760 m1),围手术期无严重并发症发生.后凸角纠正至0°~10°,最大纠正65°.随访1~4年(平均1.5年),术后6个月所有患者的结核病灶均治愈.术前合并瘫痪者,2例Frankel B级者恢复至D级,其余8例均恢复至E级.末次随访时未见内固定松动断裂及结核复发征象.结论 一期后路多节段椎弓根螺钉固定矫形联合前路病灶清除植骨融合,是治疗合并严重后凸畸形的活动性胸腰椎结核安全、有效的方案.

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abstracts:

Objective To explore an effective and reasonable surgical strategy for active spinal tuberculosis with severe kyohotic deformity(kyphotic angle≥45°).Methods From January 2004 to January 2008,30 consecutive patients of active spinal tuberculosis complicated with significant angulation were enrolled in this study,including 8 male and 22 female.The average age was 35 years(range,7-60years),with average angle of kyphosis of 58°(range,45°-70°).There were 28 patients complicated with intraspinal abscess,of which 10 patients presented with incomplete paraplegia According to the Frankd's scoring system,there were 2 patients with Frankel Grade B,6 with Grade C,2 with Grade D.After antituberculous chemotherapy(HREZ)for at least 2 weeks,all patients underwent posterior multiple-level pedicle screw instrumentation and kyphotic correction,and then received anterior debridement,decompression and supportive bone grafting,all of which were completed in the same day.The postoperative standardized chemotherapy was 6HREZ/6-12HRE.The angle of kyphosis.curve correction after surgery,and recovery of paraplegia were analyzed.Fusion status and erythrocyte sedimentation rate were recorded to determine the presence of active disease.Results Operative time was 4 to 6 hours(average 5.2 h),blood loss was 600 to 900 ml(average 760 ml).No perioperative Severe complications occurred.The kyphotic angle was corrected to O°-10°,and the maximum corrected angle was 65°.The average follow-up duration was 18 months(range,12-48m).All patients showed evidence of solid fusion and healing of the active disease at 6 months follow-up.Neurologic deficits were improved:2 patients from B to D,6 patients from C to E,2 patients from D to E.No recurrence of the tuberculosis infection or instrumentation failure happened at final follow-up.Conclusion Combined posterior instrumentation and anterior debridement,fusion surgery in one stage is proved to be successful in treating spinal tuberculosis,correcting the kyphosis,and providing solid fusion.

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作者: 李晶 [1] 吕国华 [1] 王孝宾 [1] 王冰 [1] 卢畅 [1] 邓幼文 [1]
第一作者: 李晶
期刊: 《中华外科杂志》2010年48卷8期 597-600页 MEDLINEISTICPKUCSCD
分类号: R6
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2010.08.011
发布时间: 2010-06-29
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