中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (44): 7120-7124.doi: 10.3969/j.issn.2095-4344.2015.44.013

• 脊柱植入物 spinal implant • 上一篇    下一篇

单节段胸腰椎结核植骨融合内固定：有效重建脊柱稳定性及矫正畸形

陈 涛，贾世青，刘昌生，赖英静，张 翔   

  1. 玉林市中西医结合骨科医院，广西壮族自治区玉林市 537000
  • 收稿日期:2015-09-01 出版日期:2015-10-22 发布日期:2015-10-22
  • 作者简介:陈涛，主治医师。

Bone graft fusion fixation for single-segment thoracic/lumbar spinal tuberculosis: effective reconstruction of spinal stabilization and deformity correction

Chen Tao, Jia Shi-qing, Liu Chang-sheng, Lai Ying-jing, Zhang Xiang   

  1. Yulin Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine, Yulin 537000, Guangxi Zhuang Autonomous Region, China
  • Received:2015-09-01 Online:2015-10-22 Published:2015-10-22
  • About author:Chen Tao, Attending physician, Yulin Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine, Yulin 537000, Guangxi Zhuang Autonomous Region, China

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摘要：

背景：在彻底病灶清除的基础上，同期前路或分期行后路内固定已成为脊柱结核外科治疗的标准方案。虽然大量文献证实二者均取得良好的效果，但是也存在前路解剖结构复杂，创伤大，并发症相对较多，操作及内固定物置入困难等一系列缺点。
目的：观察后路经椎间隙病灶清除及椎间植骨融合内固定治疗后单节段胸腰椎结核患者脊柱稳定性及畸形矫正情况。
方法：回顾性分析2008年1月至2012年1月广西玉林市中西医结合骨科医院收治的行一期后路经椎间隙病灶清除植骨融合内固定治疗的单节段胸腰椎结核患者36例，病变节段T11/12节段2例，T12/L1节段4例，L3/4节段6例，L4/5节段22例，L5/S1节段2例；其中24例患者有不同程度的脊髓神经损伤表现。治疗后6，12，24个月对所有患者进行随访，观察植骨融合、后凸畸形矫正、脊髓功能恢复及并发症发生情况。
结果与结论：治疗后随访24-38个月。治疗后2年患者后凸Cobb角、椎管狭窄率较治疗前显著改善(P < 0.05)。末次随访患者腰椎背部疼痛症状均明显缓解(P < 0.05)，椎间融合率为100%。治疗后随访无病灶残留及复发，无矫正丢失，无内固定松动、移位等并发症。提示对于单节段胸腰椎结核患者，后路经椎间隙病灶清除及椎间植骨融合内固定能够有效重建脊柱稳定性，矫正畸形，促进脊髓神经功能恢复。
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨科植入物, 脊柱植入物, 胸腰椎, 结核, 脊柱融合术, Cobb角, 神经功能, 随访

Abstract:

BACKGROUND: On the basis of thorough debridement, homochronous anterior or staging posterior fixation has been a standard scheme for spinal tuberculosis. Numerous studies confirmed that above approach has obtained good effects, but the anterior approach has some disadvantages, such as complex anatomic structure, great trauma, relatively more complications, and difficult operation and fixator implantation.
OBJECTIVE: To observe spinal stabilization and deformity correction in patients with single-segment thoracic/lumbar spinal tuberculosis after posterior debridement and interbody fusion.
METHODS: Clinical data of 36 patients with single-segment thoracic/lumbar spinal tuberculosis undergoing one-stage posterior debridement and interbody fusion in the Guangxi Yulin Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine from January 2008 to January 2012 were retrospectively analyzed. There were 2 cases in single T11/12 segment, 4 in T12/L1 segments, 6 in L3/4 segments, 22 in L4/5 segments 
and 2 in L5/S1 segments. Of them, 24 patients suffered from different degrees of spinal nerve injury. At 6, 12 and 24 months after surgery, all patients were followed up. Bone graft fusion, kyphosis correction, functional recovery of the spinal cord and complications were observed.
RESULTS AND CONCLUSION: All patients were followed up for 24-38 months. Cobb angle of kyphosis and spinal stenosis rate were significantly improved at 2 years after treatment (P < 0.05). The lumbar back pain symptoms were significantly improved in final follow-up (P < 0.05), with an intervertebral fusion rate of 100%. No lesion residue and recurrence, correction loss, fixation loosening or displacement was found. These results demonstrated that in patients with single-segment thoracic/lumbar spinal tuberculosis, posterior debridement and interbody fusion can effectively reconstruct spinal stabilization, correct deformity, and promote the functional recovery of spinal nerves.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Spinal Fusion, Thoracic Vertebrae, Lumbar Vertebrae, Tuberculosis, Spinal, Follow-Up Studies, Tissue Engineering