前路病灶清除椎体间植骨结合后路椎弓根内固定治疗腰骶椎结核

目的：探讨前路病灶清除椎体间植骨结合后路椎弓根内固定治疗腰骶段结核的临床疗效.方法：对2005年1月至2012年6月收治的18例腰骶椎结核患者进行回顾性分析,男12例,女6例;年龄35～67岁,平均44岁;病程4～17个月,平均9个月.其中单纯腰痛2例,腰痛伴下肢放射痛3例,下肢肌力感觉减退者13例.神经功能Frankel分级：C级3例,D级10例,E级5例.病灶部位：L4.58例,L54例,LS16例.术前腰骶角15°～27°,血沉45～93 mm/h.均采用前路病灶清除椎体间植骨结合后路椎弓根内固定治疗,应用腰骶角测量、血沉检测和神经功能Frankel分级来评估临床疗效.结果：18例均获随访,时间14 ～22个月,手术时间平均180 min;出血量400～800 ml,术中1例发生髂静脉损伤,术后4例出现不同程度腹胀,无脊髓损伤及其他严重并发症,腰腿痛症状均消失,Frankel分级有不同程度提高,X线、CT检查显示18例患者于术后9～13个月植骨融合,腰骶角和血沉末次随访时与术前比较均显著改善（P＜0.05）.结论：前路病灶清除椎体间植骨结合后路椎弓根内固定是治疗腰骶椎结核的一种有效手术方法.

Surgical treatment of lumbosacral tuberculosis by anterior debridement,bone graft,and posterior pedicle screw-rod internal fixation

Objective: To investigate the effectiveness of anterior debridement,bone graft,and posterior pedicle screw-rod internal fixation in the treatment of lumbosacral tuberculosis.Methods: From January 2005 to June 2012,18 patients with lumbosacral tuberculosis undergoing the surgical treatment by anterior debridement,bone graft,and posterior pedicle screw-rod internal fixation were reviewed retrospectively. There were 12 males and 6 females with an average age of 44 years old ranging from 35 to 67. Among them,2 cases were simple low back pain,3 cases were low back pain combined with radiating pain of lower extremity and 13 cases were muscle strength hypesthesia. According to Fankle grading,the nerve function was grade C in 3 cases,grade D in 10 cases,grade E in 5 cases. Of these cases,L4,5 was involved in 8 cases,L5 in 4 cases and L5S1 in 6 cases. The lumbosacral angle was 15° to 27° and the erythrocyte sedimentation rate (ESR) was 45 to 93 mm/h before treatment. The clinical indexes including the lumbosacral incidence,Frankel grade and ESR were reviewed at follow-up.Results: All 18 cases were followed up for 14 to 22 months. The mean operation time was 180 min. The amount of bleeding was 400 to 800 ml. Except 1 case with iliac vein injuried and 4 cases with abdominal distension,no spinal injuries and severe relative complication occurred,and neurologic function improved in various degrees. Pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray and CT films demonstrated that bony fusion was obtained in all patients during 9 to 13 months postoperatively. The lumbosacral angle and ESR were improved significantly.Conclusion: Anterior debridement,bone graft,and posterior pedicle screw-rod internal fixation is an effective method in dealing with lumbosacral spine tuberculosis.