前路Ⅰ期病灶清除加植骨融合内固定治疗腰骶段结核

目的:探讨经前路腹膜外途径Ⅰ期病灶清除、植骨融合、单钉棒内固定治疗腰骶段结核的临床效果。方法:2005年3月至2011年2月采用经前路腹膜外途径,彻底清除病灶,大块髂骨支撑植骨,单钉棒椎体侧前方内固定治疗腰骶段(L3-S1)结核18例,男13例,女5例;年龄24～61岁,平均38.5岁;病程3～14个月,平均5.5个月。病变节段:L3,42例,L4,55例,L42例,L5S16例,L4-S13例。术后常规抗结核治疗12～18个月,定期复查血沉及CT、X线片,监测抗结核治疗效果及植骨融合情况。结果:术中显露充分,病灶清除彻底,无大血管、神经、输尿管损伤等严重并发症发生。随访6～42个月,平均13个月。内固定无松动、断裂;植骨块无移位,植骨融合良好;血沉、C-反应蛋白正常,结核病变无复发。结论:经前路腹膜外途径行病灶清除、植骨融合、单钉棒内固定治疗腰骶段结核,能Ⅰ期完成病变的切除和腰骶椎的重建,在此区域单钉棒内固定是可行的。

One stage anterior debridement,bone fusion and internal fixation for the treatment of lumbosacral tuberculosis

Objective: To explore the clinical effect of the anterior debridement,bone fusion,single screw-rod fixation for the treatment of lumbosacral tuberculosis.Methods: From March 2005 to February 2011,18 patients with lumbosacral (L₃-S₁) tuberculosis (including 13 males and 5 females with an average age of 38.5 years old ranging from 24 to 61 years) were treated with removing focus completely,large piece of iliac bone strut grafting,single screw-rod vertebral lateral anterior internal fixation through anterior extraperitoneal approach. The process segment was L_3,4 in 2 cases,L_4,5 in 5,L₄ in 2,L₅S₁ in 6,L₄-S₁ in 3. All patients were routinely treated with antituberculous druy for 12-18 months after operation,erythrocyte sedimentation rate and liver function,X-ray films,CT examination,were statedly rechecked,and condition of antituberculosis treatment and bone grafting fusion were detected.Results: Intraoperative focus were exposed clearly,debrided thoroughly. There were no large blood vessels,nerves,ureteral injury and other serious complications during operation. All patients were followed up form 6 to 42 months with an average of 13 months. Internal fixations were not loosening,breaking;bone of grafting was not displacementand obtained good healing;erythrocyte sedimentation rate and C-reactive protein were normal;tuberculosis lesions were not recurrence.Conclusion: Through anterior extraperitoneal approach to remove focus,bone fusion,single screw-rod fixation in treating lumbosacral tuberculosis can complete cut lesion and rebuild the stability of lumbosacral vertebrae,in this area with a single screw and rod fixation is a feasible method.