经Wiltse入路病灶清除并椎间非结构性植骨融合内固定术治疗单节段胸腰椎结核

Treatment of single-segment thoracolumbar tuberculosis with debridement through Wiltse approach combined with intervertebral nonstructural bone grafting

目的探讨经Wiltse入路病灶清除并椎间非结构性植骨治疗单节段胸腰椎结核的可行性及其临床疗效。方法2016年6月-2019年8月,四川大学华西医院资阳医院采用经Wiltse入路病灶清除并椎间非结构性植骨治疗单节段胸腰椎结核患者24例,所有患者术前均规范抗结核药物治疗2~4周。记录手术时间、术中出血量、术后引流量及术中输注红细胞悬液单位数,以及术前、术后1周和末次随访时疼痛视觉模拟量表(VAS)评分、Cobb角和红细胞沉降率(ESR),观察神经功能缓解情况和植骨融合情况。结果所有手术顺利完成。所有患者随访超过6个月。手术时间为(267±35)min,术中出血量为(490±160)mL,术中输红细胞悬液(1.3±0.2)个单位,术后引流量为(180±20)mL。末次随访时所有患者VAS评分、Cobb角、ESR均较术前显著改善,差异有统计学意义(P<0.05);5例术前脊髓神经功能障碍者术后均有所改善,术前Frankel分级C级1例恢复至D级,D级4例均恢复至E级。术后复查影像学资料示植骨均融合,无内固定松动、窦道形成或结核复发等情况发生。结论经Wiltse入路病灶清除并椎间非结构性植骨治疗单节段胸腰椎结核临床疗效满意。

Objective To investigate the feasibility and clinical efficacy of debridement through Wiltse approach combined with intervertebral nonstructural bone grafting for treatment of single-segment thoracolumbar tuberculosis.Methods From June 2016 to August 2019,24 patients with single-segment thoracolumbar tuberculosis were treated with debridement through Wiltse approach combined with intervertebral nonstructural bone grafting in Ziyang Hospital of West China Hospital of Sichuan University,and all the patients were treated with standard anti-tuberculosis drugs for 2-4 weeks before operation.The operation time,intraoperative blood loss,intraoperative transfusion of red blood cell suspension,postoperative drainage,visual analogue scale(VAS)score,Cobb's angle and erythrocyte sedimentation rate(ESR)at pre-operation,postoperative 1 week and final follow-up were recorded.The remission of neurological symptoms and bone graft fusion were observed.Results All the operations were successfully completed.All the patients were followed up for more than 6 months.The operation time was(267±35)min;the intraoperative blood loss was(490±160)mL;the intraoperative transfusion of red blood cell suspension was(1.3±0.2)units;and postoperative drainage was(180±20)mL.At the final follow-up,VAS score,Cobb's angle and ESR were significantly improved in all patients,all with a statistical significance(P<0.05).Spinal cord nerve disability were improved after operation in 5 cases(Frankel grade C recovered to grade D in 1,grade D recovered to grade E in 4).The postoperative imaging data showed that all the bone grafts were fused without internal fixation loosening,sinus formation or tuberculosis recurrence.Conclusion The therapeutic effect of debridement through Wiltse approach combined with intervertebral nonstructural bone grafting for single-segment thoracolumbar tuberculosis is satisfactory.