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目的探讨小儿胸腰椎结核不同手术方式的适应证和疗效。方法回顾性分析本院确诊为胸腰椎结核的21例患儿的临床资料。患儿经2～4周的正规三联或四联抗结核药物治疗后,采用不同的前、后路手术方式。其中13例采用单纯病灶清除术,5例采用侧前路病灶清除并植骨融合术,3例脊柱畸形较严重者采用后路病灶清除、植骨融合并内固定术。术后正规抗结核治疗1.0～1.5 a。结果除1例有慢性窦道形成,余患儿切口均一期愈合;1例并脊髓损害恢复达Ⅳ级;X线示脊柱骨性融合时间为3～8个月(平均5.6个月),植骨患儿均获骨性愈合。后凸畸形基本矫正;术后功能评价为优16例、良4例、可1例,优良率95.2%。结论小儿胸腰椎结核应根据病灶、骨破坏、畸形情况选择合适的术式,有效抗结核治疗和病灶彻底清除是治愈的关键。
Objective To investigate the indications and curative effects of different surgical methods on pediatric thoracolumbar tuberculosis. Methods The clinical data of 21 patients diagnosed as thoracolumbar tuberculosis in our hospital were retrospectively analyzed. Children with 2 to 4 weeks after the formal triple or quadruple anti-TB drug treatment, using different anterior and posterior approach. Among them, 13 cases were treated with simple debridement, 5 cases were treated with anterior lateral debridement and bone fusion, and 3 cases with more severe spinal deformity were treated with posterior lesion clearance, bone graft fusion and internal fixation. Postoperative formal anti-TB treatment 1.0 ~ 1.5 a. Results One case had chronic sinus and more than one incision healed in one time. One case had spinal cord injury recovery up to grade Ⅳ. X-ray showed spine fusion for 3-8 months (average 5.6 months) Bone children were bone healing. The kyphosis was basically corrected. The postoperative functional assessment was excellent in 16 cases, good in 4 cases and fair in 1 case, with an excellent and good rate of 95.2%. Conclusion Thoracolumbar tuberculosis in children should be based on the lesions, bone destruction, deformity, select the appropriate surgical procedures, effective anti-TB treatment and complete removal of the lesion is the key to cure.