一期后路病灶清除植骨融合内固定矫形治疗成人腰骶段结核

One-stage posterior debridement, bony graft and instrumentation for lumbosacral tuberculosis in adults

目的：探讨一期后路病灶清除植骨融合内同定矫形治疗成人腰骶段结核的临床疗效。方法：回顾性研究2004年3月-2010年10月收治的17例腰骶段结核患者，男9例，女8例；年龄23-68岁，平均46．4±16．0岁。17例患者中有16例出现不完全瘫痪，神经功能Frankel分级：B级4例，C级5例，D级7例。人院时血沉（ESR）33-95mm／h，平均57．4±16．8mm／h。术前腰骶角18°-23°，平均20．5°±1．7°。均采用一期后路病灶清除、内固定矫形、植骨融合治疗，应用腰骶角测量、血沉检测和神经功能Frankel分级评定来评论临床疗效，随访观察治疗结果。结果：全部病例手术均安全完成，手术平均用时145min（130-200min），术中平均出血约700ml（500-850ml）；无脊髓及血管损伤及其他严重并发症。全部患者随访17-71个月，平均47．5°±17．1个月。末次随访腰骶角为25．9°-30.3°，平均28.3°±1．5°，术后ESR恢复正常（9．2±3．1mm／h），均较术前明显改善（P〈0．05）。术后6-8个月，复查X线、MRI提示所有患者植骨融合，神经压迫完全解除。除2例术前Frankel分级为B级的患者术后恢复至D级，其余患者术后Frankel分级均为E级。结论：一期后路病灶清除植骨融合内固定矫形治疗成人腰骶段结核疗效确切，安全可靠。

Objectives： To evaluate the clinical outcome and feasibility of one-stage posterior debridement, bony graft, and instrumentation for lumbosacral tuberculosis in adults. Methods： 17 patients suffering from lumbosacral tuberculosis admitted into our hospital between March 2004 and October 2010 and treated by one-stage posterior debridement, bony graft, and instrumentation were reviewed retrospectively. The clinical in- dexes including the lumbosacral incidence, Frankel grade and ESR were reviewed at follow-up. Results： The average operation time was 145min（130-200min）, and the average blood loss was 700ml（500-850ml）. The av- erage follow-up period was 47.5±17.1 months（17-71 months）. No instrument related complication was noted or neurologic function improved in various degrees. The mean lumbosaeral incidence was 20.5±1.7 degrees （18.0-23.0 degrees） before operation and 29.1±1.5 degrees（26.4-31.0 degrees） after operation. The average ESR value before intervention was 57.4±16.8mm/h （33-95ram/h） and reached 9.2±3.1mm/h in 3 months. All patients got bony fusion within 6-8 months after surgery, with 15 Bridwell Ⅰ and 2 Bridwell Ⅱ. Conclu- sions： One-stage posterior debridement, bony graft and instrumentation is effective and reliable for lum- bosacral tuberculosis in adults.