XLIF联合病灶清除内固定治疗单节段腰椎结核

Combination of XLIF, debridement and internal fixation for single-segment lumbar spinal tuberculosis

目的 探讨极外侧椎间融合（XLIF）联合病灶清除内固定治疗单节段腰椎结核的初步临床效果。方法回顾性分析2013年1月至2014年5月广西贵港市人民医院收治的9例单节段腰椎结核患者的临床资料,其中3例L1/2椎体结核、2例L2/3椎体结核、4例L3/4椎体结核,均在微创通道下行XLIF联合病灶清除内固定治疗。记录手术时间和术中出血量,评估患者手术前后视觉模拟量表（VAS）、日本骨科学会（JOA）评分,观察术后并发症及植骨融合情况。结果 所有患者均手术顺利,手术时间（70±22）min,术中出血量（110±32）m L,植骨融合时间（7.0±1.3）个月。术后随访6～13个月（平均9.6个月）。末次随访VAS、JOA评分均较术前明显改善,差异有统计学意义（P〈0.05）;末次随访JOA评分改善率为56%。2例患者术后出现左大腿前内侧皮肤感觉障碍及髂腰肌肌力下降,对症处理后3个月内恢复;随访期间影像学检查显示内固定位置良好,未出现植骨块吸收和骨不连,无结核复发病例。结论 应用XLIF联合病灶清除内固定治疗单节段腰椎结核,具有手术创伤小、并发症少、术后恢复快、可早期下床活动、明显缓解疼痛症状和改善腰椎功能等优点。

Objective To investigate the preliminary clinical effect of extreme lateral interbody fusion （XLIF）, debridement and internal fixation for treatment of single-segment lumbar spinal tuberculosis. Methods From January 2013 to May 2014, 9 patients with single-segment lumbar spinal tuberculosis including 3 patients involved in L1/2, 2 in L2/3 and 4 in L3/4, were treated by combination of XLIF, debridement and internal fixation under minimally invasive channel in Guigang People＇s Hospital, and their clinical data were analyzed retrospectively, Operation time and intraoperative estimate blood loss were recorded, visual analogue scale （VAS） and Japanese Orthopaedic Association （JOA） scores were evaluated at prcoperation and pestoperation, postoperative complications and bony fusion were also observed. Results Operations were completed smoothly in all patients. The average operation time was （70 ± 22） min, intraoperative estimate blood loss was （110±32） mL, bony fusion time was （7.0± 1.3） months. Patients were followed up for 6 to 13 months （average, 9.6 months）. VAS and JOA scores at the latest follow-up were improved compared with preoperative ones, the difference had statistical significance （P 〈0.05）; The improvement rate of JOA score was 56% at the last follow-up. Sensory disorder in anteriomedial skin of left thigh and iliopsoas muscle weakness occurred in 2 cases, and then recovered within 3 months after symptomatic treatment. Radiological examination during the follow-up showed that the fixation position was good, and there were no absorption of bone graft , bone nonunion or tuberculosis recurrence occurred. Conclusion Treatment of single-segment lumbar spinal tuberculosis by combination of XLIF, debridement and internal fixation, could relieve the symptom of pain and improve the function of lumbar vertebrae, with minimal trauma, less complications, rapid postoperative recovery and early ambulatory rehabilitation.