后路病灶清除植骨融合内固定术治疗腰椎结核

目的探讨腰椎结核行一期后路病灶清除植骨融合内固定术的临床疗效。方法 2009年5月~2012年6月,采用一期后路病灶清除植骨融合内固定术治疗42例腰椎结核患者。其中L1椎体8例,L2椎体9例,L3椎体10例,L4椎体27例,L5椎体20例;累及单节段17例,双节段18例,3个节段7例。37例患者伴有椎旁脓肿,15例伴有不同程度的硬脊膜和/或神经根受压症状。按Frankel分级C级2例,D级13例,E级27例;所有患者术前均经过≥2周抗结核治疗。结果术后平均随访2年,3例复发,其余病例术后6.5个月行X线片检查,显示椎间植骨融合,融合率为92.9%(39/42)。术后神经症状均获得明显恢复,无严重并发症。结论后路一期行病灶清除植骨融合内固定术治疗腰椎结核有利于恢复脊柱稳定性,减小手术创伤,提高植骨融合率。

Posterior debridement and interbody bone grafting fusion combined with internal fixation in treatment of lumbar tuberculosis

Objective To evaluate the clinical efficacy of posterior debridement,interbody bone grafting fusion and internal fixation in the treatment of the lumbar tuberculosis. Methods A consecutive series of 42 cases of lumbar tuberculosis from May 2009 to June 2012 were studied retrospectively.All the patients who under posterior debridement,interbody bone grafting fusion, internal fixation were evaluated.There were 8 cases of L₁,9 cases of L₂,10 cases of L₃,27 cases of L₄ and 20 cases of L₅. Besides, there were 37 cases with paraspinal abscess and 15 cases with deficit of spinal nerve. According to Frankel grade, there were 2 cases of C grade,13 cases of D grade, 27 cases of E grade. All the patients were administrated to anti-tuberculosis therapy over 2 weeks preoperatively. Results The all follow up were performed in an average of 2 years post-operation, including 3 cases recurrence.Spinal solid fusion at the interface between graft and adjacent vertebral bodies was shown radiologically in mean 6.5 months after surgery, and the rate of fusion was 92.9%(39/42). All the neurological deficit recovered without serious complication. Conclusion Posterior debridement,interbody bone grafting fusion,internal fixation are effective treatments for lumbar tuberculosis,and can reconstruct stability of spine. It could reduce the trauma of operation and improve fusion rate.