Ⅰ期后路病灶清除联合腰髂间固定植骨融合术治疗腰骶椎结核

目的：探讨Ⅰ期后路病灶清除联合腰髂间固定植骨融合术治疗腰骶椎结核的临床疗效。方法：回顾性分析2013年1月至2018年2月收治的31例腰骶椎结核患者，均采用Ⅰ期后路病灶清除联合腰髂间固定植骨融合手术治疗。病变范围为L₄-S₂，其中男18例，女13例，年龄18~77（45.9±9.1）岁。采用美国脊柱损伤协会脊髓损伤神经功能分级（ASIA分级）：B级2例，C级17例，D级12例。分析手术前后血红细胞沉降率（ESR）、C-反应蛋白（CRP）、疼痛视觉模拟评分（VAS）、ASIA分级、腰骶角及椎间隙高度变化情况，并观察手术并发症、内植物稳定性和植骨融合情况。结果：31例患者均获随访，时间为10~24（16.0±3.1）个月。1例患者术后出现局部感染、皮下积液，经换药治愈。余30例患者均Ⅰ期愈合，无窦道形成及结核复发。所有患者获治愈，未见内固定松动、断裂；植骨融合均成功，平均融合时间（4.7±1.1）个月。末次随访时患者ESR、CRP均正常，VAS评分为（1.92±0.57）分，低于术前的（6.13±1.21）分；ASIA分级C级2例，D级6例，E级23例。末次随访时腰骶角为（27.21±3.12）°，较术前的（21.42±3.75）°增大；椎间隙高度为（9.80±0.38）mm，高于术前的（7.84±0.41）mm。结论：Ⅰ期后路病灶清除联合腰髂间固定植骨融合术治疗腰骶椎结核是一种切实可行、安全有效的方法，可在临床中推荐应用。

One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis

Objective: To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis.Methods: The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females,aged from 18 to 77 years old with an average of(45.9±9.1) years. The lesion segment was form L₄ to S₂. The preoperative ASIA grading showed that 2 cases were grade B,17 cases were grade C,12 were grade D. Pre-and post-operative C reactive protein(CRP),visual analogue scale(VAS),erythrocyte sedimentation rate(ESR),ASIA grade,lumbosacral angle and intervertebral space height were analyzed,the surgery complications,stability of internal fixation,bone fusion were observed.Results: All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured,no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of(4.7±1.1) months. At the final follow-up,ESR and CRP were normal,the VAS was decreased from(6.13±1.21) points preoperatively to(1.92±0.57) pioints,the ASIA grading showed that 2 cases were grade C,6 cases were grade D,and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75)°,(7.84±0.41) mm to (27.21±3.12)°,(9.80±0.38) mm at the final follow-up,respectively.Conclusion: One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable,effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.