双侧单髂骨短钉髂腰固定术在腰5骶1椎体结核中的应用

Clinical application of placement of bilateral single short iliac screw for treatment of lumbar 5 sacral 1 vertebral tuber-culosis（23 cases analysis）

目的探讨一期后路病灶清除、双侧单髂骨短钉的髂腰固定融合术治疗腰5骶1椎体结核的临床疗效。方法收集2009年1月至2014年1月解放军第三。九医院收治的腰5骶1椎体结核患者23例。其中男14例，女9例，年龄20-56岁，平均（37．3±11．1）岁。均行后路病灶清除、植骨融合内固定术，内固定方式采取腰椎椎弓根螺钉联合双侧单髂骨短钉的髂腰固定术，术后随访18个月。比较术前、术后1周及末次随访时血红细胞沉降率（EsR）、C反应蛋白（CRP）、疼痛视觉模拟评分（VAs）、美国脊柱损伤协会脊髓损伤神经功能分级（简称“ASIA分级”）及腰骶角变化情况，定期随访观察临床疗效及Bridwell骨融合情况。结果手术时间平均（203．3±20．7）mm；出血量（652．1±127．5）ml；末次随访时ESR、CRP、VAS评分分别为（4．24±1．85）mm／1h、（0．95±0．54）mg／L、（0．91±0．67）分，均明显低于术前[分别为（36．51±5．49）mm／1h、（29．34±17．26）mg／L、（7．13±1．54）分]及术后1周[分别为（37．13±8．11）mm／1h、（31．23±3．57）mg／L、（2．26±0．62）分]，差异均有统计学意义（F=1129．76，P〈0．001；F=243．60，P〈0．001；F=156．17，P〈0．001）；末次随访时23例患者均获得骨性愈合，神经损伤ASIA分级20例恢复至E级、3例恢复至D级；腰骶角术后1周[（29．31±3．62）°]较术前[（22．45±4．38）°]明显增大，差异有统计学意义（t=-6．06，P〈0．001），末次随访时腰骶角[（27．40±3．43）°]有所丢失，但与术前相比差异仍有统计学意义（t=-4．37，P〈0．001）。术中未发生血管、神经功能损伤等并发症，术后无感染、内固定失败等患者。结论应用双侧单髂骨短钉的髂腰固定融合术能为部分腰5骶1椎体结核患者提供持续有效的脊柱稳定，并具有手术时间短、出血量少、并发症少等优点。

Objective To investigate the clinical efficacy of one-stage posterior radical debridement and recon- struction of lumbar sacral pelvic by using bilateral single short iliac screw in the treatment of lumbar 5 sacral 1 verte bral tuberculosis （TB）. Methods Twenty-three patients with lumbar 5 sacral 1 vertebral TB admitted in the 309th Hospital of PLA from January 2009 to January 2014 were recruited in this study, including 14 males and 9 females, aged from 20 to 56 years old （37.3±11.1 years）. Posterior debridement, bone graft fusion and internal fixation were performed in all recruited patients. Lumbar pedicle screws combined with bilateral single iliac screw fixation was used in the internal fixation. The patients were followed up for 18 months. Erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, visual analog scale （VAS）, ASIA status, lumbo scaral angle and bony union at preoperatively, 1 week postoperative and the last follow-up were observed and compared respectively. Results The mean time of surgery was （203.3±20. 7） min and the bleeding mount of surgery was （652.1±127.5） ml. At the last follow-up, the value of ESR, CRP, VAS were （4.24±1.85） mm/1 h, （0. 95±0. 54） mg/L and （0. 91± 0.67） points, all decreased significantly compared with the preoperative （（36.51 ± 5.49） mm/1 h, （29.34 ±17.26） mg/L, （7.13± 1.54） points） and those at 1 week postoperative （（37.13 ± 8. 11） mm/1 h, （31.23 ± 3. 57） mg/L, （2. 26±0. 62） points） ; in addition, the differences mentioned above were statistically significant （F= 1129.76, P=0. 001;F=243.60, P〈0. 001,F=156.17, P〈0. 001）. At the last follow up, all patients achieved bony union, ASIA grading of nerve injury status in all patients improved, 20 patients improved to E, 3 to D. Lum- bar scaral angle was significantly larger at 1 week postoperative （29.31±3.62） ° than that at preoperative （22.45± 4. 38） （t=-6.06, P〈0. 001）, at the last follow up, lumbar scaral angle reduced to （27. 40±3. 43） °, but the difference was still significant （t=- 4.37, P〈0. 001）. No complication occurred during and after the operation. Conclusion Part of the patients with lumbar 5 sacral I vertebral tuberculosis can benefit from the treatment of pos- terior radical debridement, posterolateral bone graft fusion and reconstruction of lumbar sacral pelvic by using bila- teral single short iliac screw as it can provide patients with the continuous and effective spinal stabilization and has several advantages, such as shorter operation time, less bleeding volume, low medical cost, less complications.