经单侧多裂肌和最长肌间隙入路一期病灶清除植骨融合内固定术治疗胸腰椎结核

目的探讨经单侧多裂肌和最长肌间隙入路一期病灶清除植骨融合内固定术治疗胸腰椎结核的临床疗效。方法回顾性分析2011年3月—2015年10月采用经单侧多裂肌和最长肌间隙入路一期病灶清除植骨融合内固定术治疗的25例胸腰椎结核患者临床资料。病变节段位于T_(10,11) 7例、T_(11,12) 10例、T_(12)～L_1 5例、L_(4,5) 3例。合并腰大肌脓肿4例,合并椎管内脓肿3例。按美国脊髓损伤协会(ASIA)分级标准,神经功能C级4例,D级2例,E级19例。记录患者术前、术后3个月及末次随访时后凸Cobb角、Oswestry功能障碍指数(ODI),红细胞沉降率(ESR)。末次随访时采用Bridwell标准评价植骨融合情况,并记录ASIA分级情况。结果全部手术均顺利完成,术口甲级愈合,术中发生硬膜囊撕裂1例,无窦道形成,未出现严重手术并发症。所有患者随访15～22个月,平均18.1个月,末次随访时均获得骨性融合。术后3个月及末次随访时后凸Cobb角、ODI及ESR均较术前明显改善,差异有统计学意义(P0.05);术前6例伴神经损伤症状的患者,除1例由C级恢复至D级,其余均恢复为E级。术后未见内固定器断裂、松脱及矫正度丢失等情况。结论采用经单侧多裂肌和最长肌间隙入路一期病灶清除植骨融合内固定术治疗短节段胸腰椎结核安全、有效。

One-stage debridement,bone grafting,fusion and internal fixation via unilateral multifidus and longissimus intermuscular approach for thoracolumbar tuberculosis

Objective To investigate the clinical effect of one-stage debridement,bone grafting,fusion and internal fixation via unilateral multifidus and longissimus intermuscular approach for thoracolumbar tuberculosis. Methods The clinical data of 25 patients with thoracolumbar tuberculosis treated by one-stage debridement,bone grafting,fusion and internal fixation via unilateral multifidus and longissimus intermuscular approach from March 2011 to October 2015 were retrospectively analyzed. The segmental lesioned at T_10,11 in 7 cases,T_11,12 in 10,T₁₂-L₁ in 5 and L_4,5 in 3. There were 4 cases of psoas major abscess and 3 of spinal canal abscess. According to American Spinal Injury Association(ASIA) classification,neurological function was grade C in 4 cases,grade D in 2 and grade E in 19. Cobb''s angle,Oswestry disability index(ODI) and erythrocyte sedimentation rate(ESR) were recorded at pre-operation,postoperative 3 months and final follow-up. At the final follow-up,Bridwell criteria was used to evaluate the fusion of bone grafts,and ASIA classification was recorded. Results The operations were successfully completed in all the patients without severe surical complications,with excellent incision healing. The patients were followed up for 15-22 months with a mean of 18.1 months. Bone fusion was achieved in all the patients at the final follow-up. ODI,Cobb''s angle,and ESR were significantly improved at postoperative 3 months and final follow-up compared with those at pre-operation,and the differences were statistically significant(P < 0.05). Of the 6 patients with neurological defects at pre-operation,except 1 recovering from grade C to D,the rest recovered to grade E. No complications such as internal fixation loosening,breaking or reduction loss was found after operation. Conclution It is safe and effective to treat short-segment thoracolumbar tuberculosis by one-stage debridement,bone grafting,fusion and internal fixation via unilateral multifidus and longissimus intermuscular approach.