单纯后路Ⅰ期病灶清除椎间钛网植骨融合内固定治疗成人腰椎结核

Debridement,internal fixation,and reconstruction with titanium mesh for the surgical treatment of lumbar tuberculosis via a posterior-only approach in adults

目的:探讨单纯Ⅰ期后路手术治疗成人腰椎结核的临床疗效、适应证及关键技术。方法 :回顾性分析2012年3月至2014年3月采用单纯后路Ⅰ期手术治疗的病变累及一个运动单元的成人腰椎结核患者26例,其中男15例,女11例;年龄21~68岁,平均44.7岁。患者术前均有腰部疼痛和(或)下肢放射性疼痛。分析患者术后并发症、结核复发、血沉变化、影像学及腰腿痛改善情况(VAS评分)。结果:26例患者均顺利实施手术,手术时间2~4 h,平均(2.4±0.8)h,术中出血量200~700 ml,平均(320±86)ml;腰腿痛VAS评分术前(5.7±1.4)分,术后2周降至(1.6±0.5)分;术前血沉(42.8±10.4)mm/h,术后3个月降为(12.1±5.6)mm/h。26例患者均获随访,时间为24~48个月,平均(28.3±5.8)个月。1例术后2个月结核复发窦道形成,经清创放置局部引流加强抗痨术后3个月窦道愈合;术后1年26例患者椎体间植骨均牢固愈合,至末次随访未见结核局部复发。结论:对于病变累及一个运动单元的成人腰椎结核,单纯后路Ⅰ期手术是一种可行、有效的方法;对合并继发性椎管狭窄症的成人腰椎结核,单纯Ⅰ期后路手术是其最佳适应证。

Objective： To investigate the clinical effects,indications and key techniques of debridement,internal fixation,and reconstruction with titanium mesh in lumbar tuberculosis via a posterior-only approach in adults.Methods： The clinical data of 26 patients with monosegment lumbar tuberculosis treated with surgery from March 2012 to March 2014 was retrospectively analyzed. Among them,15 cases were male and 11 cases were female,and patients＇ age ranged from 21 to 68 years old （average,44.7 years old）. All patients suffered from back pain and/or pain with radiation to the legs. The clinical efficacy was evaluated based on the complications,erythrocyte sedimentation rate （ESR）,imaging examination,and back and leg pain score of visual analogue scale （VAS）.Results： All operations were successful in 26 patients with an average operation time of （2.4±0.8） h （range from 2 to 4 h）,with an average blood loss of （320±86） ml（range from 200 to 700 ml） .VAS was decreased from （5.7±1.4） points preoperatively to （1.6±0.5） points 2 weeks postoperatively （P〈0.01）;and ESR was decreased from （42.8±10.4）mm/h preoperatively to （12.1±5.6）mm/h 3 months after surgery （P〈0.01）. All the patients were followed up for 24 to 48 months with an average of（28.3±5.8） months. One patients suffered from the recurrence of TB and sinus tract formation at 2 months after surgery,and was cured by stronger anti-tuberculosis drugs,local debridement with drainage,and sinus tract healed at 3 months after operation. All intervertebral bone graft obtained fusion within 1 year after operation and no local recurrence of TB was found at final follow-up.Conclusion： Debridement,internal fixation,and reconstruction with titanium mesh via a posterior-only approach is a effective and safe method for the treatment of monosegment lumbar tuberculosis,especially for the patients with secondary spinal stenosis.