直接外侧椎间植骨融合联合后路经皮螺钉固定治疗腰椎结核

目的:探讨直接外侧椎间植骨融合联合后路经皮螺钉固定治疗腰椎结核的临床疗效及优越性。方法 :对2013年6月至2016年8月采用手术治疗的83例腰椎结核患者的临床资料进行回顾性分析,其中男55例,女28例;年龄27～72(49.5±13.5)岁。83例患者根据术式不同分为两组,其中A组35例,行直接外侧椎间植骨融合联合后路经皮螺钉固定术;B组48例,行前路传统腹膜外入路病灶清除联合后路内固定术。术后继续正规四联抗结核药物治疗18个月。比较两组手术时间、术中出血量、住院时间、植骨融合时间及并发症。统计手术前后腰部疼痛的视觉模拟评分(visual analogue score,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI),病变节段的矢状面Cobb角,红细胞沉降率(erythrocyte sedimentation rate,ESR)及C-反应蛋白(C-reactive protein,CRP)值,对比分析不同时间点以上参数变化。结果:两组患者均顺利完成手术,术中未改变手术方式。手术时间、术中出血量、住院时间A组分别为(149.4±13.3) min、(354.3±69.0) ml、(9.4±1.6)d,B组为(116.8±10.0) min、(721.9±172.3) ml、(11.8±1.7) d,两组差异有统计学意义(P0.05)。随访时间A组为(24.2±5.1)个月,B组为(24.0±5.0)个月,两组差异无统计学意义(P0.05)。术后4个月随访时发现A组1例手术对侧腰大肌脓肿增大,行二次手术排脓后治愈。余82例均Ⅰ期愈合,随访期间无窦道形成、脑脊液漏及内固定松动、断裂、远端交界性后凸畸形等情况。融合时间A组为(5.1±1.6)个月,B组为(5.1±1.7)个月,两组差异无统计学意义(P0.05)。两组患者末次随访时的VAS、ODI评分、病变节段的矢状面Cobb角、ESR及CRP值均较术前明显改善(P0.05),但两组差异无统计学意义(P0.05)。结论:两种手术方式均能获得满意的临床疗效。而直接外侧椎间植骨融合联合后路经皮螺钉固定技术能减少术中出血,降低住院时间,利于患者早期康复。

Minimally invasive direct lateral approach debridement,interbody bone grafting,and interbody fusion combined with posterior percutaneous pedicle screw fixation for lumbar spinal tuberculosis

Objective: To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.Methods: From June 2013 to August 2016,the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed,including 55 males and 28 females,aged from 27 to 72(49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods,35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation,regular quadruple antituberculosis drugs were continued for 18 months. The operation time,intraoperative blood loss,hospital stay,bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain,Oswestry Disability Index (ODI),sagittal Cobb angle,erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.Result: The operation was successfully completed in both groups,and the operation mode was not changed during operation. The operation time,intraoperative blood loss and hospital stay were (149.4±13.3) min,(354.3±69.0) ml,(9.4±1.6) d in group A and(116.8±10.0) min,(721.9±172.3) ml,(11.8±1.7) d in group B,respectively,with significant difference between the two groups(P<0.05). The follow-up time was (24.2±5.1) months in group A and (24.0±5.0) months in group B,there was no significant difference between two groups (P>0.05). At the follow-up of 4 months after operation,one patient in group A was found to have enlarged psoas major abscess on the contralateral side,and was cured after secondary operation. No sinus formation,cerebrospinal fluid leakage,internal fixation loosening,fracture or distal junction kyphosis were found during follow-up. The fusion time was (5.1±1.6) months in group A and(5.1±1.7) months in group B,there was no significant difference between two groups(P>0.05). The VAS,ODI score,sagittal Cobb angle,ESR and CRP value of the lesion segment at the last follow-up of the two groups were significantly improved(P<0.05),but there was no significant difference between two groups (P>0.05).Conclusion: The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay,which is conducive to early rehabilitation of patients.