后路病灶清除内固定治疗腰骶段结核

 目的 评价单纯后路经椎板或经椎间孔病灶清除植骨内固定术在腰骶段结核治疗中的应用及疗效。方法 2004年 1月至 2009年 10月.共 32例腰骶段结核患者选择单纯后路病灶清除植骨内固定术。男 21例.女 11例;年龄 32~65岁.平均 46岁。 L3.4节段 3例.L4.5节段 19例.L5S1节段 10例。 20例采用经椎板间病灶清除.12例采用经椎间孔病灶清除。临床疗效评价包括改良 Prolo功能评分、疼痛视觉模拟评分(visual analogue scale.VAS).影像学评价包括腰骶段受累区的后凸角、椎体高度的丢失。结果 32例患者均获得 12~24个月随访.平均 16个月。经椎板入路者术前后凸角平均为-24.3°.术后为-34.8°.终未随访时为-32.4°;经椎间孔入路者术前后凸角平均为-25.4°.术后为-35.2°.终未随访时为-33.6°.术后较术前有显著改善。根据改良 Prolo功能评分.术后疗效优良率达 93.8%。 VAS评分显示.术前平均 7.6分.术后平均 2.9°.术后比术前有显著降低。结论单纯后路经椎板或经椎间孔病灶清除植骨内固定术是治疗腰骶段结核的有效方法。正确的适应证选择、仔细的影像学评价和彻底的病灶清除是手术成功的关键。

Debridement and interbody fusion by a single posterior approach for the treatment of lumbosacral regional spinal tuberculosis

Objective To evaluate the clinical effects of a single posterior translaminal or transforaminal debridement and internal fixation with bone graft for the treatment of lumbosacral regional spinal tuberculosis. Methods From January 2004 to October 2009, 32 patients with lumbosacral regional spinal tuberculosis were treated by a single posterior debridement and internal fixation with bone graft, including 21 males and 11 females with the mean age of 46 years (range, 32-65). The lesions located: 3 in L3,4, 19 in L4,5, 10 in L5S1. 20 cases were pedormed operation via translaminal approach, 12 via transforaminal approach. The modified Prolo scale, visual analogue scale (VAS), kyphosis angle and the vertebral body loss were measured before and after surgery, and in the final follow-up. Results All the patients were followed up for average 16 months (range, 12-24). The pre-, postoperative and final follow-up mean kyphosis angle were -24.3°,-34.8°, and -32.4° in the translaminal group, -25.4°, -35.2°, and 33.6° in the transforaminal group,respectively. According to the modified Prolo scale, the excellent and good result was 93.8%. VAS decreased significantly from 7.6 points to 2.9 after surgery. Conclusion Debridement and internal fixation with bone graft via a single posterior approach for the treatment of lumbosacral regional spinal tuberculosis was an easy and effective technique. The appropriate selection of indications, careful imaging evaluation and thorough surgical debridement played an important role in the treatment of lumbosacral regional spinal tuberculosis.