病灶清除植骨内固定治疗腰骶段结核

Treatment of lumbosacral tuberculosis by debridement and internal fixation

目的探讨病灶清除植骨内固定治疗腰骶段结核的临床效果。方法 2006年1月～2009年6月,行病灶清除植骨内固定治疗腰骶段结核的患者共38例。其中一期侧前路病灶清除植骨并后路内固定26例,经腹直肌旁入路病灶清除植骨内固定3例,后路病灶清除内固定9例。结果患者术后随访12～24个月,平均14个月。患者视觉模拟量表(visual analog scale,VAS)评分显著降低,由术前平均7.2分降至1.8分(P<0.05)。末次随访神经功能均恢复至Frankel E级,术后1年植骨融合率为100%,未见内固定松动、断裂情况。抗结核药物治疗结束后3～6个月,复查血沉、C-反应蛋白均在正常范围内,术后脊柱结核无复发。1例患者术后出现根性麻木,2例患者出现窦道。结论以正规抗结核化疗为基础,病灶清除植骨内固定治疗腰骶段结核的临床疗效满意。

Objective To investigate the clinical effect of debridement bone grafting and internal fixation for the treatment of lumbosacral tuberculosis. Methods From January 2006 to June 2009,38 patients with lumbosacral tuberculosis underwent debridement and internal fixation. Twenty-six patients underwent one-stage anterolateral debridement, allograft and posterior internal fixation; 3 patients underwent anterior debridement and interbody autografting by a paramedian incision through the medial edge of the rectus abdominal muscle and retroperitoneal route; 9 patients underwent one stage posterior focal cleaning, hone grafting and internal fixation. Results All patients were followed up for 12-24 months （mean 14 months）. Visual analog scale （VAS） score decreased significantly from preoperative average of 7.2 points to 1.8 points （P 〈0.05 ）. At final followup,all patients improved to Frankel E grade. No instrument failure and tuberculosis recurrence was noted. Bone fusion was observed in all cases with the average time of 7.8 months. Of all patients, 3-6 months after the end of the anti-TB drug thera- py, the erythrocyte sedimentation rate and C-reactive protein were in the normal range. One patient had radicular numbness, 2 patients had sinus. Conclusion The clinical results of the treatment of lumbosacral tuberculosis with debridement and inter- nal fixation are satisfactory on the basis of formal anti-TB treatment.