前路微创联合后路病灶清除内固定治疗腰椎结核伴腰大肌脓肿的临床效果分析

Clinical efficacy of anterior minimally invasive drainage combined with posterior debridement and internal fixation in treatment of lumbar spinal tuberculosis with psoas abscess

目的探讨前路微创联合后路病灶清除内固定治疗腰椎结核伴腰大肌脓肿的临床效果。方法选取2015年1月至2017年8月青海大学附属医院收治的腰椎结核伴腰大肌脓肿患者25例。所有患者采用前路3～4 cm的小切口微创清除脓肿、引流,再经后路半椎关节病灶清除、矫形、自体骨植骨内固定。手术前后均给予标准化抗结核治疗,随访患者临床症状、实验室指标及影像学检查情况。结果所有患者随访时间9～38个月,平均(18±3)个月;术后Cobb角0°～13°,平均(5.7±2.6)°,末次随访Cobb角2°～18°,平均(8.8±4.2)°,后凸角度平均丢失(4.6±1.3)°;末次随访时神经功能明显改善,Frankel分级D级3例,E级22例;植骨于随访6～12个月后获得融合,所有患者均未出现结核复发。结论前路微创取髂骨并清除腰大肌脓肿加后路半椎关节病灶清除、矫形、植骨内固定的创伤小,手术时间短,出血少,是一种腰椎结核伴腰大肌脓肿的理想手术方式。

Objective To explore the clinical curative effect of anterior minimally invasive drainage combined with posterior debridement and internal fixation on lumbar spinal tuberculosis with psoas abscess. Methods Twenty-five cases of lumbar spinal tuberculosis with psoas abscess were enrolled from January 2015 to August 2017 in Affiliated Hospital of Qinghai University. All patients were treated by a 3-4 cm incision anterior approach, minimally invasive debridement and drainage, followed by posterior half vertebral joint debridement, orthopedic and autogenous bone graft internal fixation. Standardized anti-tuberculosis treatment was given before and after the operation. Clinical symptoms, laboratory indexes and imaging examinations were analyzed after treatment. Results All patients were followed up for 9-38 months; the average follow-up time was （ 18 ±3）months. Postoperative Cobb angle was 0°-13°; the average postoperative Cobb angle was （5.7 ± 2.6）°; the Cobb angle of the last follow-up was 2 °-18 ° ; the average Cobb angle of the last follow-up was （ 8.8 ±4.2 ）°. The average loss of kyphosis angle was （4.6 ±1.3 ） °. Nerve function was significantly improved; there were 3 cases of Frankel grade D and 22 cases of Frankel grade E at the last follow-up. Bone graft fused in 6-12 months after operation. All patients had no recurrence of tuberculosis. Conclusion Anterior minimally invasive drainage combined with posterior debridement and internal fixation is an ideal surgical procedure for lumbar spinal tuberculosis with psoas abscess.