前路病灶清除后路椎弓根固定治疗腰椎结核

目的探讨前后路联合Ⅰ期手术治疗腰椎结核的效果。方法采用后路椎弓根钉内固定同时前路病灶清除及椎间植骨融合治疗腰椎结核患者43例。术后随访12~33个月,平均(20±2)个月。在X线片上测量术前、术后后凸角度(Cobb角),观察植骨融合情况,应用Frankel分级评分评估神经恢复情况。结果平均手术时间(3.0±0.5)h,术中平均出血(600±50)mL。43例患者术后切口均甲级愈合,未发生感染现象,未见窦道形成。植骨块均骨性融合,局部无复发,术后X线片显示后凸畸形角度矫正10°~25,°平均(14±2)°,随访1 a以上至植骨块融合时,角度丢失0°~3°,平均(2±1)°,所有患者均未发生后凸畸形加重。15例有神经症状患者术后均有一定程度的恢复。结论前后路联合Ⅰ期手术治疗腰椎结核可以促进植骨融合和神经功能恢复,防止后凸畸形,临床疗效满意。

Anterior debridement and postenior vertebral arch fixation in treating lumbar vertebra tuberculosis

Objective To discuss the therapeutic effect of anterior and posterior treatment combined with I-stage surgery in treating lumbar vertebra tuberculosis. Methods Along with anterior debridement and bone graft fusion,43 cases with lumbar vertebra tuberculosis were treated with posterior vertebral arch fixation. The follow-up period after surgery was 12 -33 months, averaging （20 ± 2） months. The degree of the preoperative and postoperative kyphosis （ Cobb angle） were measured by X-ray films and the bone graft fusion was observed. The status of neurological recovery was assessed by the Frankel grading system. Results The average operation time was （ 3.0 ± 0.5 ） h, and the intraoperatie bleeding was （600 ± 50 ） mL. Postoperative incision healed well in the 43 cases, with no infection and no fistula. Pieces of bone graft fused, without local relapse. Postoperative X-ray film showed that angle correction after protrusion deformity was 10°- 25°, averagely （ 14 ± 2）°. More than I year＇s follow-up was done till the pieces of bone graft were fused, angle-lost were 0° - 3°, averagely （ 2 ± 1 ）°. No kyphosis deformity was found in all cases. 15 cases with neural symptom recovered to some degree. Conclusion Anterior and posterior treatment combined with I-stage surgery in treating lumbar vertebra tuberculosis can enhance the fusion of bone graft and the recovery of neurological function,and prevent progression of kyphosis. The clinical effect is satisfactory.