分期后路短节段固定前路病灶清除植骨融合治疗儿童下腰椎结核

Posterior short-segment instrumenation and anterior debridement and fusion for lower lumbar spinal tuberculosis in children

目的:探讨一期后路钉钩棒短节段内固定、二期前路病灶清除植骨融合术治疗儿童下腰椎结核的手术方法及疗效。方法:2004年5月～2008年2月共收治儿童下腰椎结核患者9例,其中男5例,女4例,年龄5～11岁,平均7.8岁。术前腰椎局部前凸角-18°～4°,平均-8.6°±7.4°。均无明显的腰椎后凸畸形。病变累及一个椎体1例,累及2个椎体7例,累及3个椎体1例。术前神经功能Frankel分级:B级1例,C级3例,D级5例。均采用一期行后路短节段内固定,二期行前路病灶清除植骨融合手术治疗。观察比较术前、术后及末次随访时患者局部前凸角,评估植骨融合情况及神经功能恢复情况。结果:所有病例均获随访,随访时间30～53个月,平均41.0±7.8个月。术后腰椎局部前凸角5°～11°,平均8.8°±1.7°,较术前明显改善(P<0.05)。末次随访时腰椎局部前凸角为5°～10°,平均7.3°±1.7°,较术后无明显角度丢失(P>0.05)。1例末次随访时神经功能Frankel分级仍为D级,余患者神经功能均恢复至正常。随访期间无内固定松动及断裂,植骨获得满意融合,无结核复发。结论:对于无明显后凸畸形的儿童下腰椎结核患者,一期后路钉钩棒系统短节段内固定、二期前路病灶清除植骨融合术,是一种安全有效的治疗方法。

Objective：To evaluate the surgical methods and clinical effect of posterior short-segment instrumenation and anterior debridement and fusion for lower lumbar spinal tuberculosis in children.Method：9 children with lower lumbar spinal tuberculosis in our institute between May 2004 and February 2008 were reviewed retrospectively.There were 5 males and 4 females with a mean age at surgery of 7.8 years old（range,5 to 11）.There was Frankel′s grade B in 1 patient,grade C in 3 and grade D in 5.The mean preoperative local lordosis angle was-8.6°±7.4°（range,-18°-4°）.No significant lumbar kyphosis was noted in all cases.2 cases had 1 vertebral body involved respectively,7 cases had 2 vertebral bodies involved respectively and 1 case had 3 vertebral bodies involved.All cases underwent posterior short-segment instrumentation followed by second-stage anterior debridement and fusion.Preoperative,postoperative and final follow-up lordosis angles were recorded and compared.Fusion status and neurological function were evaluated.Result：All cases were followed-up for a mean of 41.0±7.8 months（range,30-53 months）.The postoperative lordosis angle averaged 8.8°±1.7°（range 5°-11°）,which showed significant difference between pre and postoperative lordosis angle（P〈0.05）.The final follow-up lordosis angle averaged 7.3°±1.7°（range,5°-10°）,and no significant loss of correction was noted（P〉0.05）.All cases except one Frankel D got complete neurological recovery at final follow-up.No instrument failure was noted.Bony fusion was achieved in all cases without recurrence.Conclusion：Posterior short-segment instrumenation and anterior debridement and fusion is indicated for lower lumbar spinal tuberculosis complicated with no significant lumbar kyphosis in children.