腰骶段脊柱结核的手术治疗

Surgical treatment for lumbarsacral junction tuberculosis

目的探讨腰骶段脊柱结核手术治疗的临床效果。方法回顾性分析手术治疗并获得完整随访资料的腰骶段脊柱结核19例。病损均位于L5S1,累及2个椎体。有神经根功能损害者7例。术前抗结核药物治疗2～3周,结核中毒症状减轻后行单纯前路病灶清除术9例,前路病灶清除植骨融合术3例,后路椎弓根螺钉固定前路病灶清除植骨融合术7例,术后继续抗结核药物治疗10～12个月。随访1～5年,平均2.4年。结果 19例切口均Ⅰ期愈合,血沉于术后2～3个月恢复到正常。有神经根功能损害者1～2个月完全恢复正常,腰骶角减小者,平均矫正8°,椎间植骨者6～8个月均获骨性融合,植骨块无移位和吸收,随访期内钉棒无松动与折断,结核病灶无复发。结论腰骶段脊柱结核应根据每个患者具体的破坏程度和腰骶稳定性改变,采用不同的手术方式治疗,均能获得较好疗效。

Objective To evaluate the clinical efficacy of the surgical treatment for lnmbarsacral junction tuberculosis. Methods 19 eases of the lumbarsaeral junction tuberculosis were treated with surgical treatment in one stage. All patients under- went preoperative chemotherapy for 2 - 3 weeks. When decreasing of ESR and getting relief of tuberculosis symptoms, 9 cases un- derwent anterolateral debridement,3 cases underwent one-stage anterelateral debridement and autograft, 7 cases underwent posteri- or screw instrumentation plus anterior debridement and autograft. All patients were followed up for 1 ~ 5 years （ average 2.4 years）. Results The wound healed after surgery. Their lession were eliminated completely. The graft fused 6 ~ 8 months after surgery. The ESR of these patients decreased to a nomal level 2 to 3 months after surgery. There was no recurrence within follw-up period in all the patients. The internal fixation not loosely breaks off. Conclusion Lumbarsacral junction tuberculosis should ac- cording to each patient specific extent of damage and lumbarsacral junction stability change, use different operation method treat- ment, all can obtain good effect.