一期后路短节段固定并病灶旷置术治疗老年腰骶椎结核

目的评价一期后路短节段固定并病灶旷置术治疗老年腰骶椎结核的疗效。方法 2007年1月—2013年12月共收治48例老年腰骶椎结核患者,均采用一期后路钉棒系统短节段内固定联合腰骶椎病灶旷置(将链霉素粉剂填塞入"开窗的椎间隙"之间)治疗。记录手术时间、出血量、植骨融合时间及手术并发症。采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)和美国脊髓损伤协会(ASIA)神经功能分级评估手术疗效。结果所有患者随访28~86个月,平均63个月。手术时间(139.5±51.8)min,出血量(220.8±71.5)m L,植骨融合时间(4.5±1.7)个月,末次随访时植骨均获得骨性融合。除3例ASIA神经功能分级为D级的患者神经功能无变化外,其余有神经损伤患者均恢复至E级。患者均未出现大血管、神经损伤及伤口深部感染。术后1例患者由于疼痛复发而二期再行椎板减压病灶清除内固定;1例患者发生皮神经痛,给予非甾体镇痛药物塞来昔布口服,随访时患者疼痛消失。结论对于伴有神经症状或顽固性疼痛,但不伴有脓肿和死骨的腰骶椎结核患者行一期后路短节段固定结合病灶旷置术抗结核药物治疗效果好,能同时获得缓解腰骶部疼痛、神经根减压、维持稳定及融合的效果,但应注意严格掌握手术指征。

One-stage posterior short-segment fixation combined with lesion-putting aside therapy for lumbar and sacral tuberculosis in old patients

Objective To evaluate the therapeutic effect of one-stage posterior short-segment fixation combined with lesion exclusion therapy(lesion-putting aside therapy) for lumbar and sacral tuberculosis in old patients. Methods From January 2007 to December 2013, 48 old patients with lumbar and sacral spinal tuberculosis were treated with one-stage posterior short-segment fixation combined with lesion exclusion therapy(filling the fenestrated intervertebral space with streptomycin powder). The operative time, blood loss, the bony fusion time and surgical complications were recorded. To evaluate the improvement of back pain and recovery of neurological deficits, visual analogue scale(VAS) score, Oswestry disability index(ODI) and American Spinal Injury Association(ASIA) classification were used. Results The follow-up time ranged 28-86 months, mean 63 months. The operative time was (139.5±51.8) min;the blood loss was (220.8±71.5) mL. The bony fusion was achieved 4.5±1.7 months after the operation in all the patients. Except for 3 patients of ASIA D grade, the neurological function of other patients all recovered to normal(E grade). No injury of the major vessel, neurological deficit and deep wound infection were observed. Second-stage decompressive laminectomy and lesion debridement were performed to relive the recurrent pain in 1 patient. Cutaneous neuralgia was seen in 1 patient, and relieved by non-steroidal analgesics drug. Conclusion One-stage posterior short-segment fixation combined with lesion exclusion therapy is suitable for lumbar and sacral tuberculosis in patients with neurological symptoms and refractory pain but without sequestrum and abscess. It can obtain the effect of relieving pain, nerve root decompression, maintaining stability and fusion simultaneously. However, the indication for this surgical procedure should be discussed before the operation.