前后联合入路治疗腰骶椎结核31例临床观察

目的：探讨前路清除病灶、植骨联合后路经椎弓根钉棒系统治疗腰骶椎结核的临床疗效。方法选取该院2010年收治的31例腰骶椎结核患者为研究对象，病变部位为下腰椎及骶椎，术前抗结核治疗3周以上，采用后路椎弓根钉棒系统内固定，联合前路病灶清除、椎间植骨（髂骨）。术后卧床休息6～12周，持续使用抗结核药物12～18个月。结果随访12～43个月，有1例形成窦道，双侧形成脓肿，经再次手术切除窦道、清脓后愈合，植骨块无移位，结核病灶均愈合；13例有神经症状者基本恢复；31例术后随访未见椎体滑移，椎体高度、后突畸形矫正及椎体稳定性恢复满意，植骨于术后5～9个月骨性融合，无内固定松动、断裂。结论前后联合入路能彻底清除结核病灶和充分脊髓神经减压，矫正脊柱后凸畸形及坚强的三柱稳定性。

Clinical observation of combined anterior and posterior surgeries approach for the treatment of lumbosacral tuberculosis in 31 cases

Objective To investigate the safety and clinical effect of combined anterior and posterior surgeries approach for the treatment of lumbosacral tuberculosis .Methods There were 31 cases of low lumbar and sacrum spinal tuberculosis in this se‐ries .All cases that anti‐tuberculosis treatment lasted 3 weeks before the operation received posterior transpedicular screw system in‐ternal fixation ,anterior radical focus debridement and auto‐grafting with iliac bone .Bed rest was for 6-12 weeks after surgery and no brace was needed .Anti‐tuberculosis treatment lasted 12 -18 months .Results The period follow‐up was 12 -43 months and there was one case of the formation of the sinus and bilateral abscess after surgical resection of re‐healing ,and there was no cases of bone block displacement .All tuberculosis lesions were healing .13 cases with neurological symptoms had recovery .There was no spondylolisthesis postoperative follow‐up;The heigh ,kyphosis correction and restore stability of vertebral body were satisfied .The patients had solid bony fusion without internal fixation loosening and rupture after 5-9 months .Conclusion It is a safe and effec‐tive method to treat lumbosacral tuberculosis by posterior transpedicular screw system internal fixation and anterior radical focus debridement with interbody autografting .which can thoroughly clear focus of spinal tuberculosis ,decompress sufficiently spinal cord ,correct effectively the kyphosis deformity and achieve the stability of a strong three‐column .