腰骶段脊柱结核的外科治疗

目的　评估腰骶段脊柱结核的手术方法和临床疗效。方法 回顾性分析1997年3月-2004年3月收治的53例腰骶段脊柱结核患者的疗效,其中有37例接受手术治疗(21例接受一期前路病灶清除植骨并后路内固定,16例接受后路病灶清除植骨经椎弓根内固定),手术患者正规抗结核药物化疗9～12个月。结果 术后4周37例手术患者腰骶部疼痛明显缓解或消失,术后6周34例患者体质量明显增加,血红细胞沉降率趋于正常。有36例患者术后12个月病灶治愈,1例患者病灶不愈合伴内固定松动。单节段植骨融合时间平均4.7个月,双节段平均6.3个月。结论 腰骶段结核前路清除病灶和植骨不困难,但内固定安放困难,需联合后路内固定才能保证植骨块的稳定。后路手术能够清除局限于椎间盘和椎管内的病灶,同期完成植骨和内固定。

Surgical treatment of spinal tuberculosis in lumbosacral region

Objective To evaluate the effect of surgery and its clinical outcome in treating pa- tients with lumbosacral spine tuberculosis.Methods Retrospective analysis was conducted to ana- lyze the treatment outcome of 53 patients with lumbosacral spine tuberculosis.Among them,37 pa- tients received surgical treatment(with 21 patients had anterior debridement and auto-grafting;16 patients had posterior debridement and auto-grafting.All patients had standard anti-tuberculosis chemotherapy for 9-12 months.Results Low-back pain in the 37 patients was relived substantially or disappeared 4 weeks after the operation.Weight was gained in 34 patients and ESR in majority of patients became normal 6 weeks after the operation.Focus was absorbed in 36 patients 12 months after operation.Focus was not absorbed in 1 patient with the internal auto-grafting becoming loose Average fusion duration was 4 months for one-segment and 6 months for two-segment.Focus was absorbed in 36 patients.Conclusions Surgical strategy of spinal tuberculosis in lumbosacral region is based on focus character.Anterior approach is appropriate for lesions debridement and bone graft,and posterior is essential for stabilization because anterior internal fixation is difficult.Poste- rior debridement is indicated for lesions localized in vertebral body and disc,and simultaneously the bone graft and internal fixation are operated.