一期前后路联合手术治疗脊柱胸腰椎结核

目的评价一期前后路联合手术治疗脊柱胸腰椎结核的疗效。方法我院2002年6月。2008年12月收治35例脊柱胸腰椎结核患者，病变均累计2个或2个以上椎体，合并椎旁脓肿32例。患者术前脊髓神经功能损伤20例，Frankel分级：B级4例，C级10例，D级6例，血沉尽可能控制40mm／h以下后手术，手术方式均采用I期后路钉棒系统固定联合前路病灶清除，自体髂骨或肋骨植骨或钛网植骨融合术，随诊观察患者术后神经功能恢复情况及骨愈合情况。结果平均手术时间（4．5±0．6）h，平均出血量（600±120）ml。术中4例发生胸膜撕裂，行术中缝合，放置引流，术后无并发症发生；2例手术侧大腿前内侧放射痛麻木，经治疗后逐渐消失，1例术后1月余出现复发，伤口不愈合，经再手术后治愈，无大血管、神经损伤，无死亡病例。术后随访3月-5年（平均17．6月），骨融合时间平均6．5月，术后神经功能均恢复至E级，1—2月后血沉均恢复至正常，末次随访无1例出现明显矫正度丢失。结论脊柱胸、腰椎结核采用一期前后路联合手术，能同时解决病灶清除、减压、稳定、融合等问题，疗效确切，操作易掌握，对前方结构干扰小，是治疗脊柱胸、腰椎结核一种安全有效的方法。

Effect of the treatment of thoracic and lumbar spinal tuberculosis by one - stage surgery combined anterior and posterior operation

Objective To evaluate the curative effect of one - stage combined anterior and posterior approaches in the treatment of thoracic and lumbar spinal tuberculosis. Methods From June 2002 to December 2008, 35 patients with thoracic and lumbar spinal tuberculosis were treated with one - stage combined anterior and posterior approachs. The segments of thoracic and lumbar vertebrae were involved with two or no less than two, 19 cases had paravertebral abscess. 20 cases had neurological deficits （4 cases in Frankel B, 10 cases in Frankel C, 6 cases in Frankel D）. All the cases underwent one- stage combined anterior debridement with iliac pong fusion or titanium net bony fusion, and posterior pedicle screw - rod. To observe the recovery of neurological deficits and bong fusion. Results The operative time was （4.5 ± 0. 6） h on an average and the average blood loss was （600 ± 120） ml. 1 case had pleural membrane laceration, it was sutured during operation and no complication occurred after operation. 2 patients felt pain and numbness in the left limb, which were relieved with treatment; 1 case had edema of left limb, the symptoms subsided by raising limb effectively and passive motion of the limb. 1 case was palindromia sign of paravertebral abscess, and the incisions hadn＇ t healed, It healed with another operation. There are no injuries of large blood vessels and nerves, no death case occurred. All the cases were followed - up from three months to five years（average 17.6 months）, the bony fusion occurred in 6.5 months, the neurological function of all cases had recovered to Frankel E and ESR became normal after 1 or 2 months. Conclusion To Multiple- level thoracic and lumbar spinal tuberculosis, the combined anterior and posterior approach in one - stage is a safe and effectiye method. It＇s operation is easy to be mastered and is a few interference with anterior structure . It can complete debridement, decompression, stabilization and fusion simultaneously.