患椎间短椎弓根螺钉在单节段腰骶椎结核稳定性重建中的临床研究

目的证明后路患椎间短椎弓根螺钉固定治疗单节段腰骶椎结核的可行性,并探讨其适应证及疗效。方法 204例诊断明确、脊柱后凸畸形35°,符合纳入标准的单节段腰、骶椎结核患者,随机分为2组,均先进行后路矫形、内固定手术,同期或二期进行前路彻底病灶清除、椎体间自体髂骨支撑植骨融合术。其中短钉组104例,选用长20~35 mm的短椎弓根钉置于患椎椎弓根。如1个患椎剩余骨质1/3,而另1个患椎剩余骨质1/3,则行短钉、常规螺钉固定。长钉组:常规椎弓根螺钉置于患椎相邻的正常椎骨中,固定范围跨越患椎上、下各1个正常间隙。所有患者均采用四联化疗方案。结果 2组患者平均随访62.1个月。术后均无严重并发症发生,末次随访时,所有患者均治愈,无内固定松动及断裂现象。植骨平均愈合时间,短钉组4.3个月,长钉组4.6个月,Cobb角矫正度及丢失率2组分别为13.26°±3.76°,6.22%和16.35°±2.63°,5.24%,2组比较差异无统计学意义(P0.05),组内术前术后比较差异有统计学意义(P0.05)。血沉与C反应蛋白的术前术后差异无统计学意义。2组患者术后2年生活、工作基本恢复正常。短钉组患者术后功能恢复较长钉组好。结论腰、骶椎结核后路患椎间短椎弓根钉固定、前路病灶彻底清除术具有仅融合、固定病变节段,保留相邻正常的脊柱运动单元功能,术后脊柱功能恢复好等优点,具有很高的临床应用价值。

Clinical comparative study of short pedicle screws in treatment of single-segment lumbar and sacral vertebral lesion by posterior fixation surgery

Objective To confirm the feasibility of short pedicle screws in treatment of single-segment lumbar and sacral vertebral lesion by posterior fixation surgery, and discuss the indications and curative effect.Methods A total of 204 patients diagnosed definitely with Cobb's angle < 35° and accord with the standard single segmental lumbosacral vertebral tuberculosis were randomly divided into 2 groups. After posterior correction and internal fixation, all patients underwent anterior radical debridement and interbody fusion with bone grafting. The short screw fixation group 104 cases, with 20-35 mm pedicle screw in disease of vertebral pedicle. As one of the disease of vertebral bone remained <1/3, while the other disease vertebral bone remained>1/3, the short nails and conventional screw fixation was used. The long screw fixation group: normal vertebral pedicle screws were used in normal adjacent vertebrae, and across a normal clearance. All of the patients adopted quadruple therapy. The mean postoperative follow-up period was 62.1months. There was no serious postoperative complications. At the final follow-up, all patients were cured, and there was no internal fixation loosening and fracture phenomenon. The average bone graft healing time was 4.3 months in the short screw fixation group and 4.6 months in the long screw fixation group.Results The correction of the Cobb's angle was 13.26° ± 3.76° and the loss rate was 6.22 %, and in the short-segment group, correction of the Cobb's angle was 16.35°±2.63° and the loss rate was 5.24%. There was no statistical difference between the 2 groups (P>0.05), but there was statistical difference between pre- and post-operation within group(P<0.05). Changes of the erythrocyte sedimentation rate and C-reactive protein had no statistical differences. All patients returned to normal life and work. Patients in the short screw group got better postoperative functional recovery compared with the long screw group.Conclusion Single-segment pedicle screw fixation and correction surgery can fix and fuse the diseased segment in lumbar and sacral tuberculosis, retain normal movement in the adjacent spinal column, and promote functional recovery of the spinal column postoperatively. It can be regarded as a cost-effective means of treatment with lumbar and sacral tuberculosis.