前后路联合手术治疗腰骶段脊柱结核19例的疗效观察

Combined anterior and posterior surgeries in the treatment of lumbosacral tuberculous spondylitis

目的探讨前后路联合手术治疗腰骶脊柱结核的临床可行性及疗效。方法 2006年3月～2009年3月我科采用后路器械固定、前路彻底病灶清除植骨的方法治疗腰骶脊柱结核19例,其中累及2个节段17例,3个节段2例;术前后凸角8。～21。,平均15.3。;所有患者均伴有不同程度的椎旁脓肿及椎管内死骨形成,13例伴有不同程度的脊髓和(或)神经根受压症状,Frankel分级C级5例,D级8例。结果随访6月～3年,平均24月。术后切口均Ⅰ期愈合,结核无复发。疗效优12例,良7例。术后6月X线片检查示融合节段有连续骨小梁形成并通过椎间隙13例,2例术后CT扫描证实前方有假关节形成。融合时间6～8月,平均7.5月。术后后凸成角2。～6。,平均3.1。。至未次随访时,椎间隙高度较术后无明显丢失。有神经压迫症状者术后Frankel评分均达到E级。结论前后路联合手术治疗腰骶脊柱结核有利于恢复脊柱的稳定性、提高植骨融合率、纠正和预防后凸畸形,提高临床治愈率。

Objective To explore the clinical value and efficacy of combined anterior and posterior operation for lumbosacral tuberculous spondylitis. Methods From March 2006 to March 2009, 19 cases of lumbosacral tu- berculous spondylitis were treated using posterior spinal instrumentation and fixation, anterior debridement and thorough method of treatment. 17 cases were involved two segments, 2 cases were involved 3 segments. Kyphosis angle were 8°- 21° before surgery, and the average was 15.3°. All patients were accompanied by different levels of paraspinal and intraspinal abscess sequestrum formation, 13 eases associated with varying degrees of spinal cord and （or） nerve root compression symptoms. Five cases were Frankel classification C grade, and 8 cases were D grade. Results The followed - up were 6 months to 3 years, an average of 24 months. Postoperative wound heal- ing were stage I , tuberculosis was without recurrence. 12 cases were excellent efficacy, and 7 cases were good.After 6 months, 13 cases showed fusion segments for a continuous period of vertebral trabecular bone formation and through space by X - ray examination, 2 cases were confirmed that the front of a pseudoarthrosis of postopera- tive by CT scan. The fusion time were 6 to 8 months, an average of 7.5 months. Postoperative Kyphosis angle were 2°- 6°, and average of 3.1°. To the last follow - up, the height of intervertebral space was no obvious post- operative loss. The nerve compression symptoms Frankel scores were achieved E - class. Conclusion Combined anterior and posterior operation of lumbosaeral spinal tuberculosis could restore spinal stability, improve fusion rates, correct and prevent kyphosis, improve the clinical cure rate.