一期后路病灶清除植骨融合内固定术治疗下腰椎结核

目的探讨一期后路病灶清除植骨融合内固定术治疗下腰椎结核的可行性及临床疗效。方法回顾性分析2009年12月—2013年12月本院收治的18例下腰椎结核并椎旁/椎管脓肿患者的临床资料。记录手术前后患者红细胞沉降率(ESR)、C反应蛋白(CRP)、病变节段Cobb角、疼痛视觉模拟量表(VAS)评分及美国脊髓损伤协会(ASIA)分级等指标,术后定期随访相关影像学检查以评估手术疗效。结果 18例患者均顺利完成手术,术中及术后无严重并发症发生。术后随访36~60(47.3±8.2)个月。术后3个月及末次随访时ESR、CRP、Cobb角及VAS评分均较术前明显改善,差异均有统计学意义(P0.05)。神经功能障碍者术后均得到不同程度恢复,末次随访时术前ASIA分级C级8例恢复至D级、E级各4例,D级6例均恢复至E级。所有患者均在术后9~18(13.2±2.1)个月获得植骨融合,无内固定松动、断裂及假关节形成。结论一期后路病灶清除植骨融合内固定术治疗下腰椎结核安全有效、并发症少,患者术后生活质量明显提高。

One-stage posterior debridement,bone grafting fusion and internal fixation for lower lumbar tuberculosis

Objective To explore the feasibility and efficacy of one-stage posterior debridement,bone grafting fusion and internal fixation for lower lumbar tuberculosis. Methods The clinical data of 18 patients with lower lumbar tuberculosis and paravertebral/spinal canal abscess from December 2009 to December 2013 were retrospectively analyzed.The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),Cobb''s angle of lesion segments,visual analogue scale(VAS) score and American Spinal Injury Association(ASIA) classification for neurological function were recorded for all the patients,and regular review of postoperative imaging data were collected to evaluate the efficacy of the operation. Results The operation successfully completed in all the 18 patients,no serious complications occurred during and after operation. All the patients were followed up for 36-60(47.3±8.2)months. At postoperative 3 months and the final follow-up,the ESR,CRP,Cobb''s angel and VAS score were significantly improved compared with pre-operation,and the differences were statistically significant(P<0.05). All the patients with neurological disorders were improved after treatment. At the final follow-up,ASIA grades recovered from C to D in 4 cases,C to E in 4,and D to E in 6. All the patients received bone graft fusion within 9-18(13.2±2.1)months after the operation,without internal fixation loosening,fracture or false joint formation. Conclusion One-stage posterior debridement,bone grafting fusion and internal fixation for treatment of lower lumbar tuberculosis is safe and effective with less complications. The quality of life is significantly improved after treatment.