前后联合入路病灶清除植骨融合内固定治疗儿童下腰椎结核

Debridement and allograft with internal fixation via combined anterior and posterior approach for treatment of children lower lumbar tuberculosis

目的探讨前后联合入路病灶清除植骨融合内固定治疗儿童下腰椎结核的效果。方法本组均有不同程度腰背痛和脊柱后凸畸形,同时伴有低热、盗汗、消瘦等全身症状。采用一期后路内固定植骨融合前路病灶清除植骨融合术。结果术中无大血管、神经或输尿管损伤,术后随访无结核复发、切口感染、窦道形成或内固定失败等并发症,复查血沉结果正常。结论一期后路内固定植骨融合术矫形满意,前路清除结核病灶彻底,椎管减压确切,植骨融合可靠。

Objective To investigate the outcome of the children with lower lumbar tuberculosis who underwent radical debridement, reconstruction with bone allograft and internal fixation via com- bined anterior and posterior approach. Methods All the patients were invasion chronically and had continuous pain, stiffness and deformity in lower lumbar spine, accompanied with low fever,night sweat and pathologic leanness. All the patients underwent posteriorpedicle screw instrumentation through posterior approach and anterior debridement, bone grafting through exretroperitoneal approach for treatment of tuberculosis of lower lumbar spine. Results There was no injury of blood vessel, spinal cord or ureter during the surgery. There was no tuberculosis recurrence,incision infection,si- nus formation and internal fixation failure in any of these patients after surgery. ESR reexamination recovered normally. Conclusion The satisfactory effect of vertebral canal decompression and kyphosis deformity correction were obtained through the one-stage posterior approach. The anterior approach could provide direct and safe access to the lesion and the structural iliac crest allograft could work effectively to obtain the reliable fusion.