改良Galveston技术治疗腰骶椎结核

MODIFIED GALVESTON TECHNOLOGY FOR LUMBOSACRAL TUBERCULOSIS

目的探讨改良Galveston技术在治疗腰骶椎结核中的作用。方法2001年1月-2008年5月,收治19例腰骶椎结核患者。男13例,女6例;年龄21～58岁,平均38岁。病程8～22个月。病变位于L4～S13例,L5、S110例,L5～S25例,S1、21例。合并双下肢神经症状7例;神经功能根据Frankel分级,C级3例,D级4例。下腰痛JOA评分为5～22分,平均19分。合并髂窝脓肿6例,腰大肌脓肿3例,骶髂关节结核3例,肺结核2例。手术采用后路改良Galveston技术内固定加经椎管病灶清除、自体髂骨碎骨椎间植骨融合12例;后路改良Galveston技术固定加自体髂骨碎骨椎板植骨融合、前路病灶清除三面皮质骨髂骨植骨融合7例。结果术后18例切口Ⅰ期愈合;1例术后3周窦道形成,经换药处理,术后3个月窦道闭合。19例均获随访,随访时间12～82个月,平均21个月。无局部结核复发,术后6～12个月全身结核中毒症状消失。X线片示患者椎间植骨均于术后4～6个月达骨性融合。3例骶髂关节结核者病变骶髂关节融合;7例合并双下肢神经症状者症状消失,Frankel分级均达E级。末次随访时下腰痛JOA评分为22～29分,平均26分;与术前比较差异有统计学意义(P<0.05)。结论改良Galveston技术有助于重建腰骶髂骨稳定性,提高融合率,减少术后患者卧床时间。

Objective To study the clinical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. Methods From January 2001 to May 2008,19 patients with lumbosacral tuberculosis were treated,including 13 males and 6 females aged 21-58 years old （average 38 years old）. The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases,the L5,S1 level in 10 cases,the L5-S2 level in 5 cases,and the S1,2 level in 1 case. Seven cases were complicated with neural symptom of the lower limbs,3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 （average 19）. Six cases were complicated with iliac abscess,3 cases with psoas abscess,3 cases with sacroiliac joint tuberculosis,and 2 cases with pulmonary tuberculosis. For 12 patients,the operation of modified Galveston internal fixation via the posterior approach,focus debridement via vertebral canal,and interbody fusion with autogeneous iliac bone fragment grafting was performed; for 7 cases,the operation of modified Galveston internal fixation via the posterior approach,vertebral lamina fusion with autogeneous iliac bone fragment grafting,and anterior focus debridement was performed. Results The incision of 18 cases was healed by first intention,and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months （average 21 months）. There was no recurrence of the local tuberculosis,and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively,and 3 patients with sacroiliac joint tuberculosis achieved sacroiliac joint fusion. For those 7 patients with combinations of the neural symptom of the lower limbs,the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 （average 26）. There was a significant difference between preoperation and postoperation （P 〈 0.05）. Conclusion The modified Galveston technology is helpful to reconstruct the stability of lumbosacral vertebrae,improve bony fusion rate,reduce the postoperative in-bed time.