CT引导下微创手术治疗腰骶椎结核的中远期临床观察

Long-term clinical studies on the treatment of lumbosacral spinal tuberculosis with CT-guided minimally invasive surgery

目的 ：探讨CT引导下微创手术治疗腰骶椎结核的临床疗效。方法 ：对2002年1月至2013年3月收治的保守治疗无效的145例腰骶椎结核患者的临床资料进行回顾性分析,男84例,女61例;其中143例获得随访,年龄2.5-81岁,平均（42.60±17.14）岁。术后复发患者14例（6例有内固定,8例无内固定）;椎旁脓肿的患者32例。术前合并左下肢无力浅感觉差1例,肌力减退1例,此2例患者Frankel分级均为D级,其他患者为E级。144例实施CT引导下在病灶和脓肿内置管局部化疗灌注冲洗,1例行小开窗手术结合局部化疗治疗。观察患者治疗前及末次随访时的血沉及腰椎前凸角度（lumbar lordosis,LL）。结果：143例患者获随访,时间为21-149个月,平均67个月,其中73例获得5年以上随访。所有患者达临床愈合。术前血沉（44.96±12.41）mm/h,末次随访时（7.25±3.43）mm/h,两者差异有统计学意义（t=35.06,P=0.000）。治疗前腰椎前凸角为（36.32±8.55）°,末次随访时为（33.35±8.16）°,两者差异有统计学意义（t=13.90,P=0.000）。结论：经保守治疗3个月以上无效,脊柱稳定性较好且神经症状的程度在Frankel分级D级以上的患者,行微创治疗辅以全身抗结核药物化学治疗效果较好。

Objective：To evaluate the clinical effects of CT-guided percutaneous puncture and local chemotherapy for lumbosacral spinal tuberculosis. Methods：From January 2002 to March 2013,145 patients（84 males and 61 females） with lumbosacral spinal tuberculosis underwent failed conservative treatment were treated with CT-guided minimally invasive surgery. Their clinical data were retrospectively analyzed. Among them,143 patients were followed up,aged from 2.5 to 81 years with an average of（42.60±17.14） years. Fourteen cases（6 cases with internal fixation and 8 cases without internal fixation） recurred and 32 cases complicated with paraspinal abscess after operation. Preoperatively 1 case complicated with lower limb weakness and superficial sensation worse,1 case with muscle strength decrease,this 2 cases were grade D of Frankle,other cases were grade E. And 1 patient underwent fenestration operation and local chemotherapy,144 cases with CT guided percutaneous puncture and local chemotherapy. ESR and lumbar lordosis angle of all patients were observed preoperatively and final follow-up. Results：The mean follow-up time was 67 months（ranged,21 to 149 months） in 143 cases,and 73 cases more than 5 years. All patients obtained clinical healing. ESR was（44.96±12.41） mm / h before operation and（7.25±3.43） mm / h at final follow-up,there was significant difference between preoperative and postoperative（t=35.06,P=0.000）. Lumbar lordosis angle was（36.32±8.55）° before operation and（33.35±8.16）° at final follow-up,there was significant difference between preoperative and postoperative（t=13.90,P=0.000）. Conclusion：When conservative treatment fails for 3 months or more,the patients have good spinal stabilization,nerve function is more than grade D of Frankel,CT-guided percutaneous puncture and local chemotherapy can get satisfactory outcomes for lumbosacral spinal tuberculosis.