经皮椎间孔镜治疗腰椎结核临床疗效观察

Clinical efficacy of percutaneous transforaminal endoscopic discectomy on treatment of lumbar vertebrae tuberculosis

目的观察侧后入路经皮椎间孔镜治疗腰椎结核的临床疗效。方法2009年8月～2010年6月明确诊断腰4／5或腰5骶1结核患者15例，均表现为腰痛及局部活动受限，伴或不伴有结核中毒症状，均不伴有神经功能障碍，经正规抗结核治疗3月病灶无明显缩小；在正规抗结核治疗的同时，行经侧后入路经皮椎间孔镜下结核脓肿引流、病灶清除、局部抗结核药物留置。结果15例患者均获得随访，时间24～34个月。患者主观症状的评估采用VAS评分（8．1±1．6）及日常生活BI指数（34．2±15．2）进行评价。术后15例患者VAS评分（3．7±2．9）及日常生活BI指数（72．4±33．2）较术前明显改进，术后ESR21±9mm／h较术前ESR61±23mm／h明显下降，随访期间内症状和体征没有复发。结论经侧后入路椎闯孔镜病灶清除、结核脓肿引流、局部抗结核药物留置是治疗腰椎结核的有效方法，能改进化疗药物治疗效果并缩短化疗周期，获得良好的临床疗效。

Objective To explore the efficacy of percutaneous transforaminal endoscopic discectomy （PTED） to treat lumbar vertebrae tuberculosis. Methods 15 patients with single lumbar vertebrae tuberculosis admitted in our department from August 2009 to June 2010 received a total debridement of tuberculosis lesion and local medicine placed by percutaneous transforaminal endoscopic discectomy. A standardized chemotherapy scheme of 3SHRZ/15HRZ was carried out before and after the operation. Results In the 24 to 34 months＇follow-up,all patients had no lumbar vertebra tuberculosis relapsed. The outcome of the operation was evaluated through CT and MRI examination in the follow-up at 1,2, 3,6,12 and 24 months after operation. Before and after the operation,there were significant difference evaluated by VAS score and BI index （P〈0.01）. Conclusion Standard medication before and after operation and PTED should be recommended as a safe and efficacious minimally invasive surgical technique for single space lumber vertebrae tuberculosis.