Yang Xuejun, Huo Hongjun, Xiao Yulong, Fu Yu, Xing Wenhua, Zhao Yan, Feng Xiaodong
Department of Spinal Surgery, the Second Affiliated Hospital, Inner Mongolia Medical College, Hohhot Inner Mongolia, 010030, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Jan;24(1):37-40.
To summarize the effect of one-stage anterior debridement of infection in function reconstruction of anterior and middle column for the treatment of thoracolumbar spinal tuberculosis.
From January 2001 to January 2007, 65 patients with thoracolumbar spinal tuberculosis were treated with one-stage anterior debridement, decompression, autogenous bone grafts and internal fixation. There were 43 males and 22 females with an average age of 40.2 years (range, 19-64 years), including 18 cases of thoracic tuberculosis (T(4-l0)), 44 cases of thoracolumbar tuberculosis (T11-L2) and 3 cases of lumbar tuberculosis (L(3-5)). The disease course was 3 months to 10 years (median 10 months). One segment was involved in 7 cases, two segments in 54 cases and three segments in 4 cases. In 14 cases with spinal cord injury, there were 5 cases of grade C and 9 cases of grade D according to Frankel classification. The kyphotic Cobb angle was 20-65 degrees (41 degrees on average).
The operative time was 120-210 minutes (170 minutes on average), and the blood loss was 300-1500 mL (600 mL on average). Fifty-eight patients were followed up for 1-6 years (23 months on average). Abscess occurred in 2 cases at 40 days and 3 months, and healed after symptomatic management. The other incisions achieved healing by first intention. The X-ray films showed bony fusion 4-12 months (6 months on average) after operation. No tuberculosis recurred. At 12 months after operation, pain disappeared, and there were 7 cases of grade D and 7 cases of grade E according to Frankel classification. The kyphotic Cobb angle was 0-33 degrees (24 degrees on average), showing statistically significant difference (P < 0.05) when compared with preoperation.
Early reconstruction of load-bearing function and stability of anterior and middle column in the treatment of spinal tuberculosis is great significant. The application of one-stage anterior surgery with debridement, decompression, autogenous bone grafts and internal fixation in the operative treatment of thoracolumbar tuberculosis is safe and effective after a rigorous anti-tuberculosis treatment.
总结一期前路病灶清除术在胸腰段脊柱结核前中柱功能重建中的作用。
2001年1月至2007年1月，65例胸腰段脊柱结核患者接受一期前路病灶清除、减压、自体骨移植及内固定治疗。其中男性43例，女性22例，平均年龄40.2岁（19 - 64岁），包括胸椎结核18例（T(4 - 10)），胸腰段结核44例（T11 - L2），腰椎结核3例（L(3 - 5)）。病程3个月至10年（中位数10个月）。单节段受累7例，双节段受累54例，三节段受累4例。脊髓损伤14例，按Frankel分级，C级5例，D级9例。后凸Cobb角20 - 65度（平均41度）。
手术时间120 - 210分钟（平均170分钟），出血量300 - 150O毫升（平均600毫升）。58例患者随访1 - 6年（平均23个月）。40天和3个月时分别有2例发生脓肿，经对症处理后愈合。其余切口一期愈合。X线片显示术后4 - 12个月（平均6个月）骨性融合。无结核复发。术后12个月，疼痛消失，按Frankel分级，D级7例，E级7例。后凸Cobb角0 - 33度（平均24度），与术前比较差异有统计学意义（P < 0.05）。
早期重建脊柱结核前中柱的承重功能和稳定性具有重要意义。在严格抗结核治疗后，一期前路病灶清除、减压、自体骨移植及内固定手术治疗胸腰段结核安全有效。
