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重庆医科大学附属永川医院骨科
纸质出版日期:2010,
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[1]余雨,王群波,邵高海,李波.前路一期病灶清除植骨单钉棒内固定治疗多发下胸椎结核[J].重庆医科大学学报,2010,35(11):1731-1733.
YU Yu, et al. One-stage anterior debridement,allografts and internal fixation by screw-rod system for thoracic spinaltuberculosis[J]. Journal of Chongqing Medical University, 2010,35(11):1731-1733.
[1]余雨,王群波,邵高海,李波.前路一期病灶清除植骨单钉棒内固定治疗多发下胸椎结核[J].重庆医科大学学报,2010,35(11):1731-1733. DOI: 10.13406/j.cnki.cyxb.2010.11.024.
YU Yu, et al. One-stage anterior debridement,allografts and internal fixation by screw-rod system for thoracic spinaltuberculosis[J]. Journal of Chongqing Medical University, 2010,35(11):1731-1733. DOI: 10.13406/j.cnki.cyxb.2010.11.024.
目的:探讨前路单钉棒系统内固定肋骨植骨治疗多发下胸椎结核的疗效。方法:自2003年1月~2008年4月经胸膜外行病灶清除、椎管减压
肋骨植骨和单钉棒系统内固定治疗45例多发下胸椎结核;男31例
女14例;年龄30~67岁
平均41.3岁。2~3个椎体破坏31例
≥4个椎体14例;12例合并脊髓损伤Frankel分级:C级5例
D级7例;Cobb s角15°~36°
平均24.5°。术前抗结核治疗4~6周
术中彻底清除病灶、矫正后凸畸形
行肋骨植骨前路单钉棒系统内固定;术后继续抗结核治疗1.5~2年。结果:45例患者随访18~36个月
平均28个月。完全缓解28例
治愈率62.22%;部分改善13例
好转率28.89%
合计恢复率为91.22%。术后12月Frankel分级:B级1例
D级3例
E级8例;术后Cobb s角0~12°
平均5.9°
与术前比较差异有统计学意义(P<0.05);术后后凸角度平均矫正18.6°
最终1次随访后凸角度平均矫正16.7°
后凸角度平均丢失1.9°;所有植骨骨性融合。结论:前路单钉棒系统内固定治疗多发下胸椎结核
既能彻底清除病灶防止复发
又能矫正畸形、重建脊柱稳定性;由于术后抗扭转力学性能较差
应注意病人选择并需使用胸腰支具到植骨融合为止。
Objective:To evaluate the effectiveness of the operation of anterior internal fixation by one screw-rod system and rib graft for treatment of thoracic spinal tuberculosis.Methods:45 patients with thoracic spinal tuberculosis were treated by the operation of one-stage anterior debridement
spinal cord decompression
rib graft and internal fixation by screw-rod system
from Jan 2003 to Apr 2008.There were 31 males and 14 females with the mean age of 41.3 years(30 to 67 years old). According to Frankel Standard
the group had 5 cases of C and 7 cases of D.Cobb’s angles of the thoracolumbar spine ranged from 15° to 36°(average of 24.5°).All patients received antituberculosis chemotherapy for 4 to 6 weeks before operation.45 patients were constructed with rib graft and anterior internal fixation by screw-rod system.Antituberculosis chemotherapy was given for 1.5~2.0 years after surgery.Result:All patients were followed-up for 18~36 months(average 28 months).Among 45 patients
28 completely recovered(cure rate 62.22%);13 partly recovered(cure rate 28.89%)
total recovery rate being 91.22%.All patients showed successful autograft bone graft fusion.At 12 months after operation
the group had 1 case of B
3 cases of D and 8 cases of E according to Frankel Standard.Cobb’s angles of the thoracolumbar spine ranged from 0° to 12°(average of 5.9°)
showing statistically significant difference(P<0.05) when compared with that before operation.The average immediate postoperative correction of kyphosis angle was 18.6°;the average correction of kyphosis angle at the time of last follow-up was 16.7°;the average loss of correction was only 1.9°.Conclusion:Operation of anterior internal fixation by screw-rod system and rib graft for treatment of thoracic spinal tuberculosis can cure tuberculosis without recurrence and can also correct deformity and strengthen the spinal structure to prevent secondary paraplegia.
下胸椎结核前路病灶清除肋骨植骨单钉棒系统内固定
Thoracic spinal tuberculosisAnterior debridementRib graftInternal fixation by one nail-stick system
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