一期后路椎间病灶清除植骨融合内固定治疗腰骶椎结核15例

One-stage posterior intervertebral debridement,bone graft and internal fixation for the treatment of lumbosacral tuberculosis: report of 15 cases

目的评价一期后路椎间病灶清除植骨融合内固定治疗腰骶椎结核的疗效及应用指征。方法回顾分析手术治疗并获得完整随访资料的腰骶段脊柱结核15例,观察手术前后Cobb角变化、神经功能恢复情况及术后植骨融合时间。结果 15例患者术后随访1～5年,平均3年,所有患者切口均一期愈合。术后拍片显示植骨及内固定物位置良好,植骨均在3.5～7个月达到骨性融合。无内固定物松动及断裂。Cobb角平均14°,无明显矫正角度丢失,脊髓功能恢复良好。按Frankel分级,术前C级4例,术后恢复到D级1例,E级3例;术前D级11例,术后均恢复至E级。无结核复发。结论一期后路椎间病灶清除植骨融合内固定治疗腰骶椎结核,创伤小,植骨稳定,融合率高,能有效矫正后凸畸形,可获得较好的疗效。

Objective To evaluate the efficacy and application principles of one-stage posterior intervertebral debridement,bone graft and internal fixation for the treatment of lumbosacral tuberculosis. Methods A retrospective analysis was performed on the clinical data of 15 cases of lumbosacral tuberculosis who were treated by surgery and got complete follow-up data. The changes of Cobb angle,the conditions of neurological function recovery,and the time of postoperative bone fusion before and after surgery were observed. Results Fifteen patients were followed up for 1 ～ 5years,with an average of 3 years. All patients＇ incisions were primary healing. The postoperative X-ray films showed good bone graft and internal fixator position,and grafts gained bone fusion during 3. 5 to 7 months. No loosening and fracture of internal fixator was found. Cobb angle was averagely 14 degrees. No significant loss of corrective angle was found,spinal cord function recovered well. According to Frankel grade,in 4 patients with grade C before surgery,postoperative spinal cord function restored to grade D in one case,E grade in 3 cases,in 11 patients with grade D before surgery,postoperative spinal cord function retured to grade E. No recurrence of tuberculosis was found. Conclusion One-stage posterior intervertebral debridement,bone graft and internal fixation for the treatment of lumbosacral tuberculosis has advantages of less damage,better bone graft stability,higher fusion rate,effective correction of kyphosis deformity,and better therapeutic results.