腰骶椎结核患者的一期后路病灶清除椎间植骨融合内固定治疗

One-stage posterior debridement, interbody fusion, and instrumentation for lumbosacral junction tuberculosis in adults

目的探讨一期后路病灶清除、椎间植骨融合内固定治疗成人腰骶椎结核可行性及临床疗效。方法回顾性研究2008年7月至2013年7月,我科收集的16例腰骶椎(L_5,S_1)结核患者,伴有椎旁或椎管脓肿形成。其中男9例,女7例;年龄23~66岁,平均(46.7±12.5)岁;术前病变节段腰骶角为18°~24°,平均(21.9±1.9)°。术前ASIA神经功能分级:C级5例,D级8例,E级3例。均采用一期后路病灶清除、椎间植骨融合内固定手术治疗。通过研究术后并发症、VAS疼痛评分、ASIA分级、病变节段腰骶角、植骨融合时间评估手术疗效。结果所有病例术后随访32~60个月,平均(45.1±8.0)个月,术后无严重并发症发生。术后腰骶角为24°~30°,平均(28.1±1.7)°,末次随访为24°~29°,平均(27.1±1.6)°,较术前得到显著改善,差异有统计学意义(P<0.05)。有神经功能障碍者术后均得到不同程度恢复,至末次随访,根据ASIA分级,1例由C级恢复至D级,4例由C级恢复至E级,8例由D级恢复至E级,VAS疼痛评分均较术前得到明显改善,差异有统计学意义(P<0.05)。所有患者均在术后9~15个月,平均(11.6±2.2)个月达到植骨融合,无内固定松动、断裂及假关节形成。结论对于有手术适应证的腰骶椎脊柱结核成人患者,一期后路病灶清除、椎间植骨融合内固定治疗方法安全有效且并发症少,患者术后生活质量得到提高。

Objective To investigate the feasibility and the clinical efficacy of one-stage posterior debridement, interbody fusion, and instrumentation for lumbosacral junction tuberculosis in adults. Methods A retrospective study of 16 cases （ L5, S1; lumbosacral junction tuberculosis accompanied by paravertebral or spinal canal abscess ） in our department, from July 2008 to July 2013, was conducted. There were 9 males and 7 females, with the mean age of （ 46.7 ± 12.5 ） years （ range： 23 - 66 years ）. The mean lumbosacral angle of segmental spinal lesions pre- operation was （ 21.9 ± 1.9 ）° （ range： 18° - 24° ）. American Spinal Injury Association （ ASIA ）： grade C in 5 cases, grade D in 8 cases, and grade E in 3 cases. All the patients were treated with one-stage posterior debridement, interbody fusion, and instrumentation. Postoperative complications, Visual Analogue Scale （ VAS ） pain score, the ASIA, the lumbosacral angle of segmental spinal lesions and fusion time of the grafted bone were evaluated respectively to assess the feasibility and clinical efficacy. Results All patients were followed for 32 - 60 months post-operation （ mean： 45.1 ± 8.0 months ）. No severe complications occurred. The lumbosacral angle was （ 24° - 30° ） （ mean： 28.1° ± 1.7° ） after surgery, and （ 24° - 29° ） （ mean： 27.1° ± 1.6° ） at the final follow-up. Both were significantly increased （ P 〈 0.05 ）. At the final follow-up visit, neurological status of the patients with preoperative neurological deficit according to the ASIA： 1 cases of grade C recovered to grade D; 4 cases of grade C recovered to grade E; 8 cases of grade D recovered to grade E. VAS was significantly improved at the end of the follow-up （ P 〈 0.05 ）. Bone fusion occurred in all patients 9 - 15 months （ mean： 11.6 ± 2.2 months ） after surgery. No fixation loosening, breakage, or pseudoarticulation formation was observed. Conclusions One-stage posterior debridement, interbody fusion, and instrumentation are effective and feasible in the treatment of lumbosacral junction tuberculosis in adults with fewer complications and better quality of life.