后路经皮椎弓根钉固定前后联合入路治疗腰段脊柱结核16例

Surgical treatment of 16 cases of lumbar spinal tuberculosis by anterior debridement and bone graft plus posterior percutaneous pedicle screw fixation

目的观察后路经皮弓根钉固定前后联合入路治疗腰段脊柱结核的临床疗效。方法 2011年3月至2013年12月我院骨一科采用后路经皮弓根钉固定前后联合入路治疗腰段脊柱结核患者16例,其中持续性腰痛13例,伴有下肢放射痛2例,下肢肌力、感觉减退者4例,术前均给予HREZ四联抗结核药治疗两周。术后继续给予抗结核药物治疗,方案为3HREZ/9HRE。结果手术时间为150~240 min,平均210 min;术中出血为300~1 000 m L,平均700 m L。Cobb角矫正率为75%。一例术后出现腰丛神经症状,6个月后恢复。一例出现前路切口窦道,行结核杆菌耐药基因检测提示利福平耐药,更换敏感抗结核药后窦道延期愈合。术后随访时间8~24个月,平均14个月。所有患者术后腰痛及下肢放射痛症状明显缓解,下肢肌力、感觉减退者均恢复。至末次随访,均获得骨性融合,未见内固定松动、断裂、结核复发等情况。结论后路经皮弓根钉固定前椎后联合入路具有创伤小、病灶清除彻底、高融合率等优点,是治疗腰段脊柱结核的一种创新、有效的手术方法。

Objective To evaluate the clinical outcomes of surgical treatment of lumbar spinal tuberculosis by anterior debridement and bone graft plus posterior percutaneous pedicle screw fixation. Methods A total of 16 patients with lumbar tuberculosis from March 2011 to December 2013 undergoing the surgical treatment of lumbar tuberculosis by anterior debridement and bone graft plus posterior percutaneous pedicle screw fixation were reviewed retrospectively,with 13 cases complained of continuous low back pain, 2 cases complained of unilateral radiopathic leg pain and 4 cases of neurological deficit. All patients received antituberculosis chemotherapy with HREZ for two weeks before operation and 3HREZ/9HRE antituberculosis chemotherapy after surgery. Results The average surgical time was 210 minutes(in the range of 150~240 min), and the average intraoperative blood loss was 700 m L(in the range of 300~1 000 m L).No complications such as neurological injury and cerebrospinal fluid leakage were noted. Cobb angle correction rate was75%. One case had lumbar plexus symptoms postoperatively and recovery after six months. Tuberculous sinus developed in one case and healed by replacing sensitive anti-TB drugs. All patients were followed up for an average of 14months(8~24 months). The symptoms of low back pain and sciatica were relieved, and lower extremity muscle strength and hypoesthesia restored. At the last follow-up, all patients had achieved bone fusion, without internal fixation loosening, fracture and tuberculosis relapse. Conclusion Anterior debridement and bone graft plus posterior percutaneous fixation is an effective method in dealing with lumbar spinal tuberculosis, with little trauma and high fusion rate.