经腹膜外途径手术治疗腰骶椎结核

Extraperitoneal Surgical Treatment for Lumbosacral Tuberculosis of Spine

目的探讨及总结经腹膜外途径对L5S1结核进行病灶清除手术的方法及治疗效果。方法自2003年5月～2007年2月,经腹膜外途经手术治疗L5S1结核23例。其中19例结核病灶清除、椎间植骨后采用前路腰骶椎自锁钛板固定,另4例仅进行病灶清除、取髂骨椎间植骨手术。所有患者术后卧床3个月,常规抗结核治疗8～12个月,并定期进行复查,根据血沉检查、椎间融合情况确定停药及下地活动时间。结果所有患者均顺利完成手术。术后椎间植骨均获得骨性愈合,融合时间5～7个月,无一例术后出现结核复发及术中术后并发症。结论经腹膜外进行L5S1结核病灶清除手术为一种安全、有效的手术途径。在随访期间内,采用和未采用前路钢板固定的腰椎结核患者未见骨性愈合有明显差异。

Objective To investigate and summarize the methods and clinical outcomes of extraperitoneal surgical treatment for lumbosacral tuberculosis of spine. Methods Twenty- three patients with extraperitoneal surgical treatment for lumbosacral tuberculosis of LsS1 from May 2003 to February 2007 were reviewed retrospectively. The debridement, bone graft and fixation with auto- locked titanium plate were performed in 19 patients. Debridement and autologous bone graft were performed in 4 patients. All patients had a bed - rest for 3 months, and received normal anti - tuberculosis treatment for 8- 12 months. The anti - tuberculosis treatment was stopped and the patients were allowed to walk normally according to the ESR and fusion in the lumbar spine. Results All operations were successful. Every patients achieved the bone fusion after the underbody fusion for 5- 7 months. There were no complications and relapse of tuberculosis. Conclusion Extraperitoneal surgical treatment for lumbosacral tuberculosis of L5S1 ensures the outcome. There is no significant difference in bone union between with titanium plate fixation and without titanium plate fixation.