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目的尝试提出一种新的胸腰椎结核的分型方法,并评价其可行性及对胸腰椎结核临床治疗的意义。方法用回顾性研究方法分析2010年10月至2012年10月脊柱外科收治的胸腰椎结核患者102例的临床资料。根据病变部位的影像学检查及术中情况,以Denis三柱理论为分型基础,将胸腰椎结核分为4型:Ⅰ型,前柱受累;Ⅱ型,中柱受累;Ⅲ型,前、中柱受累;Ⅳ型,三柱均受累。结合患者是否合并寒性脓肿、后凸畸形和神经功能损害,将上述4型分为17个亚型,统计各型患者所占的比例以及治疗方法、手术方式和治疗效果,评价此胸腰椎结核分型方法的临床可行性及其对临床治疗的意义。结果根据上述分型方法将102例患者进行分类:(1)Ⅰ型3例,其中Ⅰa型2例,予非手术治疗;Ⅰb型1例,予单纯病灶清除术。(2)Ⅱ型2例(Ⅱa型和Ⅱd型各1例),分别予非手术治疗和经后路病灶清除、椎间植骨融合术,术后予外固定支具保护。(3)Ⅲ型76例(Ⅲa型3例,Ⅲb型21例,Ⅲc型9例,Ⅲd型4例,Ⅲe型39例),其中3例Ⅲb型患者行前后路联合病灶清除、植骨融合、内固定手术,其余73例Ⅲ型患者,均行前路病灶清除、植骨融合、内固定手术。(4)Ⅳ型21例(Ⅳb型2例,Ⅳc型2例,Ⅳd型4例,Ⅳe型13例):其中2例Ⅳb型患者行后路病灶清除、植骨融合、内固定手术,其余19例Ⅳ型患者均行前后路联合病灶清除、植骨融合、内固定术。经治疗,所有患者均恢复良好,手术治疗的99例患者中仅1例手术切口窦道形成,经换药后窦道愈合。术后复查X线见脊柱正常序列基本恢复,未见骨缺损;9例合并神经损害症状者8例获得好转。结论以Denis三柱理论为分型基础,结合患者是否合并寒性脓肿、后凸畸形和神经功能损害的新的分型方法对于胸腰椎结核的临床治疗有一定的应用价值。
Objective To propose a new method of classification of thoracolumbar tuberculosis and to evaluate its feasibility and clinical significance of thoracolumbar tuberculosis. Methods The clinical data of 102 patients with thoracolumbar tuberculosis admitted to Department of Spine Surgery from October 2010 to October 2012 were analyzed retrospectively. According to the imaging examination of the lesion and the intraoperative situation, the thoracolumbar tuberculosis was divided into 4 types on the basis of Denis three-column theory: type Ⅰ, anterior column involvement; type Ⅱ, column involvement; type Ⅲ, anterior, Column involvement; type Ⅳ, three columns are involved. Combined with the patients with cold abscess, kyphosis and neurological impairment, the above type 4 is divided into 17 subtypes, the proportion of each type of patients and the treatment methods, surgical methods and treatment, evaluation of this thoracolumbar tuberculosis Clinical feasibility of typing and its clinical significance. Results According to the above typing method, 102 patients were classified: (1) type Ⅰ in 3 cases, Ⅰa type 2 cases, non-surgical treatment; Ⅰ b type in 1 case, to simple debridement. (2) 2 cases of type Ⅱ (1 case of type Ⅱa and Ⅱd, respectively) were treated with non-surgical treatment and posterior lesion clearance and interbody fusion. Postoperative external fixator was used to protect them. (3) There were 76 cases in type Ⅲ (3 cases of type Ⅲa, 21 cases of type Ⅲb, 9 cases of type Ⅲc, 4 cases of type Ⅲd and 39 cases of type Ⅲe). Among them, 3 cases of type Ⅲb were treated with anterior and posterior combined lesion clearance and bone graft fusion , The internal fixation operation, and the remaining 73 cases of type Ⅲ patients were anterior lesion removal, fusion, internal fixation. (4) 21 cases of type IV (2 cases of type IVb, 2 cases of type IVc, 4 cases of type IVd and 13 cases of type IVe): 2 cases of type IVb were treated with posterior lesion clearance, bone fusion and internal fixation, 19 cases of type Ⅳ patients were treated with anterior and posterior combined lesion clearance, fusion, internal fixation. After treatment, all patients recovered well. Only 1 of the 99 cases treated surgically formed a sinus of the incision, and the sinus healed after dressing change. X-ray postoperative review showed normal spine recovery, no bone defects; 9 patients with symptoms of nerve damage in 8 patients improved. Conclusion Based on the Denis three-column theory, the new typing method based on the combination of patients with cold abscess, kyphosis and neurological dysfunction has certain value in the clinical treatment of thoracolumbar tuberculosis.