经皮内镜下病灶清除灌洗引流联合后路内固定治疗老年腰椎结核

Treatment of tuberculosis of lumbar spine in elderly patients with percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation

目的:探讨经皮内镜下病灶清除灌洗引流联合后路内固定治疗老年腰椎结核的临床效果和优势。方法:对2013年5月至2016年5月经皮内镜下病灶清除灌洗引流联合后路内固定治疗的32例老年腰椎结核病患者进行回顾性分析,男13例,女19例;年龄62~85岁,平均75岁;病变节段Cobb角13°~21°,平均(16.52±3.20)°。结核病灶累及节段:L_1-L_21例,L_2-L_34例,L_3-L_415例,L_4-L_510例,L_5-S_12例。比较手术前后的Cobb角、VAS评分、红细胞沉降率(ESR)、C-反应蛋白(CRP)、ASIA分级,评价患者脊柱稳定性及结核复发情况。结果:32例患者均获随访,时间12~36个月,平均24个月。3例术前伴巨大椎旁腰大肌脓肿的患者,术后灌洗引流管口出现窦道,术后3个月内愈合。其余29例均为Ⅰ期痊愈,无窦道形成。术后2周~3个月患者临床症状明显改善,没有出现严重心肺肝肾功能不全的并发症。VAS评分由术前的(6.77±1.23)分改善为术后1周的(4.71±0.69)分;Cobb角由术前的(16.52±3.20)°改善为术后1周的(4.24±1.22)°。随访期间均未出现感染或结核复发。末次随访ESR、CRP正常,ASIA分级有明显改善。结论:经皮内镜下病灶清除灌洗引流联合后路内固定是治疗老年腰椎结核简单、有效、安全的手术方式,值得临床推广。

Objective：To explore the clinical effects and advantages of percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation in the treatment of tuberculosis of lumbar spine in elderly. Methods：The clinical data of 32 patients with tuberculosis of lumbar spine received percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation fi＇om May 2013 to May 2016 were retrospectively analyzed. There were 13 males and 19 females, aged from 62 to 85 years old with an average of 75 year＇s. Lesion segmental Cobb angle was 13° to 21° with an average of （16.52±3.20） °. Tuberculosis focal involved L1-L2 of 1 case, L2-L3 of 4 cases, L3-L4 of 15 cases, L4-L5 of 10 case, L5-S1 of 2 cases. Cobb angle, VAS score, erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP） and ASIA grade were corn- pared before and after＂ operation. The stability of the spine and the recurrence of tuberculosis were evaluated. Results ： All patients were followed up for 12-36 months with the mean of 24 months. Three patients complicated with giant paravertebral psoas abscess occurred sinus tract in canal orifice of drainage tube after irrigation, and healed in 3 months after operation. Other 29 patients obtained healing of phase I without sinus tract formation. The clinical symptoms of all patients obvious improved at 2 weeks to 3 months after operation and no complications such as severe heart and lung,liver＂ and kidney dyfunction were found. VAS scores and Cobb angles were improved from preoperative （6.77±1.23） points and （16.52±3.20）° to （4.71±0.69） points and （4.24±1.22）° at 1 week after operation. No infection and tuberculosis recun＇ence were found at follow-up period. ESR and CRP were normal at final follow-up and ASIA grade had obvious improved. Conclusion： Percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation is a simple,effective and safe method for tuberculosis of lumbar spine in elderly, and is worthy to recommend its clinical use.