一期后路病灶清除、内固定治疗腰骶段脊柱结核

PRIMARY POSTERIOR DEBRIDEMENT AND INSTRUMENTATION FOR LUMBOSACRAL SPINE TUBERCULOSIS

目的：探讨后路病灶清除、内固定治疗治疗腰骶段脊柱结核的适应证及优点。方法：2002年1月至2008年12月,一期后路病灶清除、内固定、植骨融合治疗腰骶段脊柱结核11例,男6例,女5例。年龄20-48岁。病程4-15个月,平均6个月。病变位于L5、S17例,L4、5、S12例,L5、S22例;累及2个节段7例,3个节段4例。有3例伴窦道形成,3例伴不同程度的马尾和（或）神经根受压症状,3例伴有肺结核。术前后凸成角5°-14°,平均7°＋2.4°。结果：术后随访6个月-5年,平均3.1年。手术用时150-220min,平均180＋14.6min;出血量300-500ml,平均450＋38.4ml,9例切口Ⅰ期愈合,2例窦道形成,术后3月窦道闭合。疗效按Chen等标准评定,优9例,良2例。融合节段有连续骨小梁形成11例,融合时间5～7个月,平均6个月。术后后凸成角0°～4°,平均2°＋0.4°,无1例复发。结论：一期后路病灶清除、内固定、植骨融合治疗腰骶段脊柱结核主要适用于椎体后方破坏伴后方脓肿及椎管内脓肿形成者,具有操作简便、手术创伤小、有利于重建脊柱的稳定性、纠正和预防后凸畸形。

Objective： To explore the advantage and indication of primary posterior debridement and instrumentation for lumbosacral spine tuberculosis .Methods： 11 cases （ 6 male, 5 female） of lumbosacral spine tuberculosis were treated with primary posterior debridement and instrumentation from Jan.2002 to Dce.2008.The lesion was located at L5S1 in 7 patients,at L4.5S1 in 2 patients and at L5S1.2 in 2 patients. 2 vertebral bodies were involved in 7 patients,3 in 4 patients. The preoperative kyphosis was 5～14 degrees with mean of 7 degrees.Sinus and paravetrebral cold abscess were associated in 3 patients and 9 patients respectively, and 3 patients had radiculopathy. Results： The postoperative follow-up period was from 6 monthes to 3 years with mean of 8 monthes. The mean intra-operative blood loss was 450 ml （300 to 500）, the mean duration of surgery 180 minutes （150 to 220）. 9 cases of incisions were healed up primarily and 2 cases sustained sinus after operation and healed up postoperatively at 3 month.Spinal fusion was achieved in 90.9% of the patients within average 6 months after operation. The postopretive kyphosis was 0～4 degrees with mean of 2 degrees and there was no recurrence within follow-up period. Conclusion：Lumbosacral spine tuberculosis treated with this surgical technique is safe, effective and minimally invasive with restoring the spinal stability, correcting the kyphosis and preventing progression of kyphosis if lumbosacral spine tuberculosis associated with posterior lesion and abscess.