一期病灶清除植骨内固定术治疗经皮椎体后凸成形术误治后的脊柱结核

One-stage deridement and bone grafting for spinal tuberculosis after percutaneous kyphoplasty mistreatment

目的探讨一期病灶清除植骨内固定术治疗经皮椎体后凸成形术(PKP)误治后的脊柱结核的临床疗效。方法将11例经PKP误治后的脊柱结核患者行一期病灶清除植骨内固定术。记录术后疼痛VAS评分、红细胞沉降率(ESR)、C-反应蛋白(CRP)、植骨融合情况、ODI及神经功能改善情况。结果患者均获得随访,时间18~36个月。VAS评分术后1个月、末次随访均低于术前(P<0.05)。ESR、CRP术后3个月均低于术前(P<0.05)。ODI术后6个月低于术前(P<0.05)。ASIA分级:1例术前B级恢复至术后D级,2例术前D级恢复至术后E级。术后12个月植骨均达到Ⅰ级融合。结论一期病灶清除植骨内固定术治疗经PKP误治后的脊柱结核,可有效控制结核病情,改善疼痛症状,重建脊柱稳定性,提高生活质量,临床疗效满意。

Objective To investigate the clinical efficacy of one-stage deridement and bone grafting for spinal tuberculosis after percutaneous kyphoplasty(PKP)mistreatment.Methods Eleven patients with spinal tuberculosis who were mistreated by PKP underwent primary debridement and bone graft internal fixation.The postoperative pain VAS,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),bone graft fusion condition,ODI and neurological improvement were recorded.Results The patients were followed up for 18~36 months.The VAS at 1 month after operation and the last follow-up were lower than those before operation(P<0.05).ESR and CRP at 3 months after operation were lower than before operation(P<0.05).The ODI at 6 months after operation was lower than that before operation(P<0.05).One patient recovered from ASIA grade B to postoperative grade D;2 patients recovered from grade D to grade E.At 12 months of follow-up,all patients achieved gradeⅠfusion.Conclusions One-stage debridement and bone graft internal fixation for the treatment of spinal tuberculosis after PKP mistreatment can effectively control tuberculosis,improve pain symptoms,rebuild spinal stability,improve quality of life,and have satisfactory clinical effects.