一期后路单侧椎板开窗、经椎间隙入路病灶清除内固定术在胸腰椎结核的临床应用

Clinical application of one stage posterior approach with unilateral posterior vertebral lamina,internal fixation in the treatment of thoracic and lumbar spinal tuberculosis

目的探讨胸腰椎结核行一期后路单侧椎板开窗、经椎间隙入路病灶清除内固定术的疗效。方法收治24例胸腰椎结核患者,病灶节段均位于胸11-腰2椎体范围。均伴有椎旁、椎管脓肿和后凸畸形表现,按ASIA神经功能分级,其中B级3例,C级9例,D级8例,E级4例。所有患者均给予一期后路单侧椎板开窗、经椎间隙入路病灶清除内固定术治疗,术前给予严格的抗结核药物四联疗法2-4周,术后给予抗结核化疗12-18个月。结果 24例患者均顺利完成手术,手术时间为160-240 min,平均为(180.1±30.2)min;术中出血量为400-920 m L,平均为(590.3±80.6)m L。术后1例出现皮下局部脓肿,1例切口延迟愈合,均经对症处理后痊愈。所有患者随访20-40个月,随访期间未见内固定松动、断裂情况发生,无窦道形成,未见结核复发,椎间植骨均融合,融合时间为5-8个月。神经功能恢复情况:术前B级3例,恢复至C级1例,D级1例,E级1例;C级9例,恢复至D级2例,E级7例;D级8例均恢复至E级。末次随访时,血沉指标、VAS评分、ODI功能障碍指数均较术前有明显降低(P<0.05),Cobb角较术前有明显改善(P<0.05)。结论在严格的抗结核药物化疗基础上,胸腰椎结核行一期后路单侧椎板开窗、经椎间隙入路病灶清除内固定术治疗,手术创伤小,对脊柱稳定性的破坏性小,可取得明显的疗效,值得临床推广应用。

Objective To investigate the efficacy of one stage posterior approach for the treatment of unilateral posterior vertebral lamina and internal fixation in patients with thoracolumbar spinal tuberculosis. Methods 24 cases of thoracic and lumbar spinal tuberculosis were treated, and the segment of the lesion was located in the range of 11- lumbar 2 vertebral body. All patients with vertebral, spinal abscess and the performance of the deformity, according to ASIA nerve function classification, in which B grade 3 cases, C grade 9 cases, D grade 8 cases, E grade 4 cases. All patients were given unilateral laminectomy, posterior transdiscal approach debridement and internal fixation, preoperative administration of strict anti-tuberculosis drugs quadruple therapy for 2-4 weeks after anti-tuberculosis chemotherapy for 12-18 months. Results 24 patients were successfully completed the operation, the operation time was 160-240 min, average （180.1±30.2） min.The amount of bleeding was 400-920 mL, average（590.3±80.6） mL. 1 case had subcutaneous abscess and 1 patient bad delayed healing after treatment. All patients were followed up for 20-40 months, no internal fixation loosening, fracture occurred during the follow-up period, no sinus formation, no recurrence of tuberculosis, interbody fusion and fusion time was 5-8 months. Neurological function recovery：preoperative B grade 3 cases, recovery to C grade 1 case, grade D 1 case, grade E 1 case; grade C 9 cases, recovery to D grade 2 cases, E grade 7 cases; D grade 8 cases, all recovered to E level. At the end of the follow-up, erythroeyte sedimentation rate index, VAS score, ODI disability index were significantly decreased （P〈0.05）, Cobb angle was significantly improved after operation （P〈0.05）. Conclusion In strict anti-tuberculosis chemotherapy based on thoracic and lumbar tuberculosis underwent one-stage posterior unilateral laminectomy and transdiscal approach debridement and internal fixation has little trauma, less damaging to spinal stability, obvious curative effect, it is worthy of clinical application.