一期后路病灶清除植骨融合钉棒固定治疗L_5～S_1结核

One-stage posterior debridement,bone graft fusion and pedicle screw fixation in the treatment of L_5～S_1 tuberculosis

目的评价一期后路病灶清除植骨融合并钉棒固定治疗L5~S1结核的疗效。方法对23例L5~S1结核患者采用腰椎后路病灶清除植骨融合术治疗。根据疼痛视觉模拟评分（VAS）、血沉、C-反应蛋白、受累区腰骶角及植骨融合情况评价临床疗效。结果所有患者均顺利完成手术,术中出血量100~1 500（227.28±119.25）ml。23例患者均获随访,时间6~18（13.2±4.3）个月。血沉：术前（47.30±15.45）mm/1 h,术后3个月（10.43±4.47）mm/1 h,除5例高于正常值,其余恢复正常。C-反应蛋白：术前（36.01±23.60）mg/L,术后3个月（8.55±7.20）mg/L,有6例高于正常值。末次随访所有患者血沉、C-反应蛋白均正常。VAS：由术前的（4.09±2.45）分降低至末次随访的（0.65±0.71）分。腰骶角：术后30.98°±2.97°较术前23.40°±2.43°恢复7.6°,末次随访30.11°±2.75°,丢失1.0°。以上各项指标术后及末次随访与术前比较差异均有统计学意义（P〈0.05）。结论一期后路病灶清除植骨融合是治疗L5~S1结核的有效方法,术前的明确诊断、正确的适应证选择及术中的精细操作是手术成功重要因素。

Objective To evaluate the clinical efficacy of one-stage posterior debridement graft fusion and pedicle screw fixation in the treatment of L5~ S1 tuberculosis. Methods 23 patients who suffered from L5~ S1 tuberculosis were undergone surgical debridement posterior fusion surgery. The clinical efficacy was evaluated based on the materials Prolo scale,visual analogue scale（ VAS）,erythrocyte sedimentation rate（ ESR）,C-reactive protein graft fusion and change of lumbo-sacral angle. Results All patients were successfully operated,and the blood loss was 100 ~1 500（227. 28 ± 119. 25） ml. 23 patients were followed up for 6 ~ 18（13. 2 ± 4. 3） months. The preoperative ESR was（47. 30 ± 15. 45） mm /1 h,the postoperative ESR was（10. 43 ± 4. 47） mm /1 h within 3 months and most patients returned to normal except five cases. Preoperative C-reactive protein was（36. 01 ± 23. 60） mg / L,within 3 months it was changed to（8. 55 ± 7. 20） mg / L,but there was also 6 cases abnormal. Both of them were normal in the last follow-up. The VAS was（0. 65 ± 0. 71） at the last follow-up,decreased from（4. 09 ± 2. 45） preoperatively. The lumbo-sacral angle was 30. 98° ± 2. 97° compared with 23. 40° ± 2. 43° preoperatively,and restored to 7. 6°,the last follow-up was 30. 11° ± 2. 75°,loss of less than 1. 0°. Above indicators were statistically significant different in the postoperative and last follow-up compared with the preoperative（ P〈0. 05）. Conclusions One-stage posterior debridement and bone graft fusion is an effective treatment method for the treatment of lumbo-sacral tuberculosis. Preoperative diagnosis,proper selection and operative indications are important factors in the success of the operation.