后路经椎间隙病灶清除植骨内固定治疗腰骶段脊柱结核

Posterior debridement and bone grafting via intervertebral space combined with internal fixation for the treatment of lumbosacral tuberculosis

目的:探讨后路经椎间隙病灶清除植骨内固定治疗腰骶段脊柱结核的疗效。方法 :对2007年1月至2013年7月行Ⅰ期后路经椎间隙病灶清除植骨内固定手术治疗的32例腰骶段脊柱结核患者进行回顾性分析,其中男17例,女15例;年龄27~63岁,平均(49.8±9.2)岁;病程5~18个月,平均(10.7±3.2)个月;累及L5椎体者1例,L_5S_1间隙者8例,L5或S1椎体及L5S1间隙者23例。通过VAS评分、ESR、CRP、腰骶角、L_5S_1椎间高度和神经功能ASIA分级进行临床疗效评定。结果:32例患者均获随访,时间18~39个月,平均21.6个月。手术时间120~260 min,平均175 min;术中出血量700~1 450 ml,平均1 050 ml。术前VAS评分为8.4±1.6,术后3个月为3.5±0.8(P<0.05),末次随访时为1.7±0.6。术前ESR和CRP分别为(48.8±10.2)mm和(58.6±5.6)mg/L,术后3个月降至(35.6±6.9)mm和(22.5±4.3)mg/L(P<0.05);末次随访时均降至正常范围内。术前L_5S_1椎间高度及腰骶角分别为(7.7±0.4)mm和(19.3±1.2)°,术后3个月恢复至(10.3±0.3)mm和(22.4±1.5)°(P<0.05),末次随访时无明显丢失。术前ASIA分级:C级8例,D级19例,E级5例;至末次随访时,除1例仍为D级外,其余均为E级。结论:后路经椎间隙病灶清除植骨内固定可有效地清除结核病灶、维持脊柱的稳定性及改善患者的神经功能障碍,手术安全,并发症较少。

Objective： To explore the clinical effects of posterior debridement,bone grafting via intervertebral space combined with internal fixation for the treatment of lumbosacral tuberculosis.Methods： The clinical data of 32 patients with lumbosacral tuberculosis underwent the procedure of one-stage posterior intervertebral debridement,bone grafting and internal fixation from January 2007 to July 2013 were retrospectively analyzed. There were 17 males and 15 females,aged from 27 to 63 years with an average of （49.8±9.2） years. The course of disease was from 5 to 18 months with the mean of （10.7±3.2） months. There was involved the vertebral body of L5 in 1 case,the intervertebral space of L5S1 in 8 cases,and the vertebral body of L5 or S1 combined with intervertebral space of L5S1 in 23 cases. VAS,ESR,CRP,the lumbosacral angle,the height of intervertebral space of L5S1,and ASIA grade were used to evaluate clinical effects.Results： All the patients were followed up from 18 to 39 months with an average of 21.6 months. Operative time was 120 to 260 min with the mean of 175 min,and intraoperative bleeding was 700 to 1 450 ml with the mean of 1 050 ml. VAS before operation was 8.4±1.6,then descended to 3.5±0.8（P〈0.05） on the 3rd month after operation and redescended to the level of 1.7±0.6（P〈0.05） at the final follow-up. The ESR and CRP before operation were （48.8±10.2） mm and （58.6±5.6） mg/L,respectively,then decreased to （35.6±6.9） mm and （22.5±4.3） mg/L （P〈0.05） at the 3rd month after operation and returned to the normal level at the final follow-up. The height of intervertebral space of L5S1 and lumbosacral angle before operation were （7.7±0.4） mm and （19.3±1.2）°,respectively,then improved to （10.3±0.3） mm and （22.4±1.5）° on the 3rd month after operation（P〈0.05）,and maintained such level,no obvious lost at later. According to ASIA grade,8 cases were grade C,19 were grade D,5 were grade E before operation,and at final follow-up,1 case still was grade D,others were grade E.Conclusion： The procedure of posterior debridement,bone grafting via intervertebral space combined with internal fixation is an effective and safe method in treating lumbosacral tuberculosis,it can effectively debride tuberculose focus,maintain the spinal stability,and improve the dysfunction with less complication.