前路一期病灶清除植骨联合自锁钛板内固定治疗腰骶段结核

ANTERIOR APPROACH DEBRIDEMENT AND BONE GRAFTING WITH SELF-LOCKED TITANIUM PLATE INTERNAL FIXATION FOR TREATING LUMBOSACRAL TUBERCULOSIS

目的 探讨前路一期病灶清除、自体髂骨植骨、单枚自锁钛板内固定治疗腰骶段结核的临床疗效。方法 2010年2月-2014年10月,采用前路一期病灶清除、自体髂骨植骨、单枚自锁钛板内固定治疗7例腰骶段结核。男5例,女2例;年龄18~65岁,平均41.6岁。病程5~21个月,平均8个月。患者有腰骶部疼痛、下肢单侧或双侧放射性疼痛、肌力及浅感觉障碍等症状和体征;Frankel脊髓损伤分级：C级1例,D级3例,E级3例。术前影像学检查均提示L_（5）、S_（1）病变,符合结核病变表现;腰骶角16.4~28.5°,平均18.6°。红细胞沉降率为28~105 mm/1 h,平均61 mm/1 h。手术前后联合四联抗结核治疗。结果 患者手术均顺利完成,术后切口均Ⅰ期愈合,无相关并发症发生。7例均获随访,随访时间14~70个月,平均25.6个月。随访期间无复发,患者结核症状均消失、红细胞沉降率恢复正常。末次随访时,术前3例Frankel D级患者均恢复至E级,1例C级恢复至D级。2例术后出现腰骶部疼痛、取骨区疼痛,1例出现上腹部不适、纳差,经对症处理后症状消失。末次随访时腰骶角为23.4~34.2°,平均28.6°;根据Bridwell标准,5例植骨达Ⅰ级骨融合、2例Ⅱ级骨融合;未发生植骨块移位及钛板、螺钉松动、断裂等并发症。结论 前路一期病灶清除、自体髂骨植骨、单枚自锁钛板内固定治疗腰骶段结核安全、有效,可获得良好骨融合,腰骶段稳定性重建及畸形矫正维持良好。

Objective To explore the effectiveness of stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation for the treatment of lumbosacral tuberculosis. Methods Seven cases of lumbosacral tuberculosis were treated by stage I anterior approach debridement, autologous lilac crest graft, and single self-locked titanium plate internal fixation between February 2010 and October 2014. There were 5 males and 2 females, aged 18-65 years （mean, 41.6 years）. The disease duration was 5-21 months （mean, 8 months）. The patients had signs and symptoms of pain in lumbosacral region, radiating pain in unilateral lower limb or bilateral lower limbs, decreased muscular strength and disorders of superficial sensation. According to Frankel classification for spinal injury, 1 case was rated as grade C, 3 cases as grade D, and 3 cases as grade E. Preoperative imaging examination suggested Ls, $1 lesions in line with the manifestations of tuberculosis; the lumbosacral angle was 16.4-28.5° （mean, 1 o 8.6 ）. The erythrocyte sedimentation rate was 28-105 mm/l hour （mean, 61 ram/1 hour）. All patients received 4-drug antituberculosis therapy. Results All patients underwent the operation successfully and all incisions healed at stage I, without relevant complication. All patients were followed up 14-70 months （ mean, 25.6 months）. All symptoms of tuberculosis disappeared and the erythrocyte sedimentation rate returned to normal. At last follow-up, Frankel classification was returned to E from D in 3 cases, returned to D from C in 1 case. Two cases suffered from pains in the lumbosacral region and at the donor site, 1 case suffered from upper abdominal discomfort and poor appetite,but these symptoms disappeared after symptomatic treatment, At last follow-up, X-ray examination indicated that the lumbosacral angle was 23.4-34.2° （mean, 28.6°）. According to Bridwell criteria, 5 cases gained grade I bone fusion, and 2 cases gained grade II bone fusion, without migration of bone graft, or loosening or breakage of titanium plate or bolt. Conclusion Stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation is safe and effective in treating lumbosacral tuberculosis. It can achieve good bone fusion and stable lumbosacral stability, and maintain good deformity correction.