后路短节段融合固定合并二期前路病灶清除治疗幼儿腰椎结核

Staged posterior short-segment instrumented spinal fusion and anterior debridement for treatment of lumbar tuberculosis in young children

[目的]探讨一期后路短节段融合内固定、二期前路病灶清除椎间植骨治疗幼儿腰椎结核伴后凸畸形的手术方法和疗效。[方法]2006年1月~2014年6月,本院共收治年龄<7岁患有腰椎结核并后凸畸形的患儿共17例,其中男性9例,女性8例,年龄4~7岁,平均5.1岁。均采用后路一期钉棒内固定植骨融合,前路二期病灶清除椎间钛网植骨融合术治疗。观察比较患者术前术后及末次随访的节段后凸Cobb角变化,评估植骨融合情况及神经功能情况。[结果]所有病例均获得随访,随访时间10~42个月。Cobb角由术前(24.18±7.15)°减少至术后(0.12±4.24)°,差异有统计学意义(P<0.001);末次随访节段后凸(0.65±3.92)°,与术前比较差异有统计学意义(P<0.001),但与术后比较差异无统计学意义(P=0.269)。JOA评分由术前(21.53±5.04)分增加至术后(28.06±0.90)分,差异有统计学意义(P<0.001)。末次随访时,17例患者ASIA分级均恢复到E级。随访期间均未发现内固定松动、脱出、移位、断裂。[结论]对低龄儿童脊柱结核合并后凸畸形,采用一期后路短节段固定植骨融合合并二期前路病灶清除钛网植骨融合可以取得较好的疗效。

[Objective] To investigate the efficacy and feasibility of first-stage posterior short-segment instrumented spinal fusion and second-stage anterior debridement combined with interbody fusion for treatment of lumbar tuberculosis with kypho- sis in young children. [Methods] From January 2006 to June 2014, 17 children less than or equal to 7 years old who suffered from lumbar tuberculosis accompanied with kyphosis were surgically treated in our department, including 9 males and 8 fe- males, aged from 4 to 7 years with an average of 5.1 years. All the children underwent posterior short-segment instrumented spi- nal fusion at the first stage, subsequently, anterior debridement and interbody fusion with titanium mesh cage and bone graft at the second stage. The local kyphotic Cobb＇s angle, extent of spinal fusion and neurologic function were evaluated. [Results] All the children were followed up for 10 to 42 months. The local kyphotic Cobb＇s angle statistically decreased from （24.18±7.15）° preoperatively to （0.12 ±4.24）° postoperatively （P〈O.O01）, further varied to （0.65±3.92）° at the latest follow up, which was sig- nificant different to that before operation （P〈O.001）, however not statistically different to data after operation （P=0.269）. In ad- dition, JOA score considerably increased from （21.53±5.04） preoperatively to （28.06±0.90） postoperatively, with a statistical dif- ference between the two time points （P〈O.001）. Furthermore, all the children who had neurologic impairment before surgery got complete recovery of neurologic function with ASIA Grade E at the latest follow up. No loosening, displacement, and rupture of internal implants were found in any patient during follow up. [Conclusion] Staged posterior short-segment instrumented spinal fusion and anterior debridement combined interbody fusion is highly effective treatment of lumbar tuberculosis and kyphosis de- formity in young children.