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一期前路自体骨移植及内固定术在脊柱结核外科治疗中的应用

Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis.

作者信息

Dai Li-Yang, Jiang Lei-Sheng, Wang Wei, Cui Yi-Min

机构信息

Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Second Medical University, Shanghai, China.

出版信息

Spine (Phila Pa 1976). 2005 Oct 15;30(20):2342-9. doi: 10.1097/01.brs.0000182109.36973.93.

Abstract

STUDY DESIGN

Results of single-stage anterior autogenous bone grafting and instrumentation for spinal tuberculosis were reported.

OBJECTIVE

To determine the efficacy of anterior instrumentation following radical debridement and autogenous bone grafting in patients with spinal tuberculosis over a 3-year period at a single institution.

SUMMARY OF BACKGROUND DATA

Patients with spinal tuberculosis have been not always successfully treated by radical debridement and bone grafting with or without supplementary posterior instrumentation and fusion, although most surgeons use posterior instrumentation to support anterior strut grafts.

METHODS

In this prospective study, the authors evaluated 39 patients (22 male and 17 female; average age, 48 years) with spinal tuberculosis, who underwent single-stage anterior radical debridement, autogenous bone grafting, and instrumentation. The average follow-up period was 39.9 months (range, 30-54 months).

RESULTS

A solid fusion was achieved in all cases; there were 2 cases of draining fistula formation. Of all 28 patients with preoperative kyphosis, the deformity was corrected from an average of 13.5 degrees on admission to an average of 1.9 degrees after surgery. No significant loss of deformity correction was noted in these patients. There was no other recurrence of the tuberculous infection.

CONCLUSIONS

The authors think that the single-stage anterior autogenous bone grafting and instrumentation are a safe and effective method in the surgical management of spinal tuberculosis.

摘要

研究设计

报告了单阶段前路自体骨移植及器械固定治疗脊柱结核的结果。

目的

确定在单一机构对脊柱结核患者进行根治性清创及自体骨移植后前路器械固定在3年期间的疗效。

背景资料总结

脊柱结核患者采用根治性清创及植骨,无论是否辅以后路器械固定及融合,治疗并非总能成功,尽管大多数外科医生使用后路器械固定来支撑前路支撑植骨。

方法

在这项前瞻性研究中,作者评估了39例脊柱结核患者(男22例,女17例;平均年龄48岁),这些患者接受了单阶段前路根治性清创、自体骨移植及器械固定。平均随访期为39.9个月(范围为30 - 54个月)。

结果

所有病例均实现了牢固融合;有2例形成引流瘘。在所有28例术前有后凸畸形的患者中,畸形从入院时平均13.5度矫正至术后平均1.9度。这些患者未发现畸形矫正有明显丢失。结核感染无其他复发情况。

结论

作者认为单阶段前路自体骨移植及器械固定是脊柱结核外科治疗的一种安全有效的方法。

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