侧前方入路一期病灶清除植骨内固定治疗腰椎结核

Anterolateral debridement,bone graft and internal fixation for lumbar vertebra tuberculosis

目的探讨侧前方入路一期病灶清除、取髂骨植骨、钉板系统内固定治疗腰椎结核的手术方法及效果。方法 32例腰椎结核患者,术前四联抗结核治疗2周后,采取侧前方入路行一期病灶清除、前路减压、取髂骨植骨及钉板系统内固定术治疗。结果患者均能耐受手术,术中显露清楚,病灶清除彻底。手术时间为120～180min,术中出血量为700～1200ml。无手术并发症发生。术后后凸矫正10°～30°。术后患者的自觉症状均有改善。32例均得到随访,时间18～36个月。末次随访时,17例合并神经系统症状者Frankel分级:C级3例中1例恢复到D级、2例恢复到E级;D级14例全部恢复到E级。随访期内结核病灶无复发,无断钉及内固定失效发生。椎间植骨均获骨性融合,融合时间为5～9个月。结论经侧前方入路一期病灶清除、取髂骨植骨、钉板系统内固定手术是治疗腰椎结核的有效方法,具有矫正畸形、稳定脊柱、预防植骨块移位、术后患者可早期下地活动等优点。

Objective To assess the efficacy of bone graft fusion and anteriolateral spinal stabilization as an alternative treatment for lumbar vertebra tuberculosis.Methods 32 patients with tuberculosis of the lumbosacral region underwent anterior decompression,iliac bone graft fusion and screw-plate system fixation after antituberculosis medication with four kinds of drugs combined chemotherapy for at least two weeks preoperatively.Results All patients stood surgery well.The operation time was 120～180 min and the bleeding during operation was 700～1 200 ml.There was no postoperative complication.After surgery,pain relief was seen in all patients.The angle correction was 10°～30° postoperatively.All patients were followed up for 18～36 months.At the last follow-up visit,1 patient with Frankel Grade C improved to Grade D,2 patient with Grade C improved to Grade E,14 patients with Grade D improved to Grade E.There was no breakage or failure of the internal fixation during the follow up.Stable bone union was observed in all cases and the time required for fusion was 5～9 months.Conclusions Lumbar vertebra tuberculosis treated with this surgical technique can achieve a high satisfactory rate in restoring spinal stability,providing early fusion,correcting and preventing progression of lordosis.