前路病灶清除人工椎体植入单节段固定治疗腰椎结核

Anterior debridement, artificial vertebrae implantation and single segment internal fixation for the treatment of lumbar tuberculosis

目的 探讨前路病灶清除人工椎体植入单节段内固定治疗脊柱结核的临床疗效。方法 手术治疗单运动节段腰椎结核患者20例,术前常规有效抗结核治疗4-8周,术中行病灶清除、人工椎体植入、单节段椎体钉棒内固定,术后常规抗结核12-18个月。观察患者的手术时间、术中出血量、住院天数以及视觉模拟评分（VAS）、神经功能恢复情况。结果 术后VAS评分较术前明显改善（P〈0.01）,至末次随访时,神经功能Frankel分级全部恢复至E级,均未出现结核复发,无内固定失败发生。结论 腰椎结核前路病灶清除、人工椎体植入、单节段内固定可有效恢复和维持脊柱的稳定性,创伤较小,为一种值得推广的术式。

Objective To investigate the clinical effect of artificial vertebrae implanting and internal fixation for lumbar tuberculosis after anterior debridement. Methods 20 patients with lumbar tuberculosis underwent anterior debridement,artificial vertebrae implanting and internal fixation after effective TB treatment for 4 to 8 weeks. After operation,patients continued to receive TB treatment for 12 to 18 month. The operative time, blood loss,hospital stay,the visual analogue scale（VAS）and recovery of nerve function of all patients were observed. Results The operative time was（135±32） min. Blood loss was（612±41） ml. Hospital stay time was（14±4.5）days. All patients were followed up for 16 to 36 months after operation. The VAS score significantly improved after operation（P〈0.01）. All patients had nerve function recovered to grade E without TB recurrence or internal fixation failure at final follow-up. Conclusion Anterior debridement,artificial vertebrae implantation and internal fixation for the treatment of lumbar tuberculosis can maintain the alignment and stability,and has less damage,so it is a better option.