后路脊柱固定联合双侧经腹膜外病灶清除术治疗腰骶椎结核

目的探讨后路脊柱固定联合双侧经腹膜外病灶清除术治疗腰骶椎结核的临床疗效。方法2000年3月-2005年2月，采用后路脊柱固定、双侧经腹膜外病灶清除术治疗16例椎体结核患者。男11例，女5例；年龄21～56岁。结核部位：L3 4例，L4 6例，L5 4例，S1 2例。其中累及3个椎体1例，跳跃病变1例。病程6个月～6年，平均13个月。16例血沉平均40mm／h；14例WBC正常，2例稍高。X线片检查示5例椎间隙破坏变窄，7例出现病椎压缩，1例相邻2个椎体破坏严重，残余骨质嵌插重叠；16例均可见双侧腰大肌脓肿。16例CT扫描可见椎体骨质破坏、脓肿形成及数量不等的死骨。11例MRI显示椎体破坏、脓肿形成并流注到腰大肌内。患者术后进行常规抗痨治疗。结果1例术后1个月切口裂开，经对症处理后愈合；余患者切口均Ⅰ期愈合。患者获随访2～5年，平均29个月。术后即出现双大腿麻木3例，足背伸无力1例，大小便失禁1例，未作特殊处理，2周后均恢复正常；1例出现腹股沟斜疝，未作处理：6例出现视物模糊、眼睛干涩等：2例出现听力障碍，调整用药后恢复；1例再次出现低热、腰痛，卧床3个月并调整延长应用抗痨药物后痊愈。余患者均无复发。血沉均恢复正常，随访末期X线片示腰椎、腰骶椎获骨性融合13例，后凸畸形1例，椎体间形成骨桥2例。结论一次手术完成后路脊柱固定、双侧经腹膜外病灶清除术治疗腰骶椎结核有较高的安全性、可行性，可减少手术次数、缩短治疗周期、降低治疗费用、提高治疗效果。

INTERNAL FIXATION OF SPINAL COLUMN BY POSTERIOR APPROACH AND EXTRAPERITIONEAL BILATERAL FOCAL DEBRIDEMENT FOR TREATMENT OF TUBERCULOSIS OF LUMBOSACRAL VERTEBRAL BODY

OBJECTIVE: To evaluate the application value of internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement for the treatment of tuberculosis of lumbosacral vertebral body. METHODS: From March 2000 to February 2005, 16 cases of spinal tuberculosis in L3-S1 were treated with internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement. Sixteen cases included 11 males and 5 females, and the age was 21-56 years. The locations of spinal tuberculosis were L3 in 4 cases, L4 in 6, Ls in 4, and S1 in 2. The course of disease averaged 13 monthes (range 6 monthes to 6 years). The ESR of all cases was greater than 20 mm/h (average 40 mm/h); WBC was normal in 14 cases, and a little high in 2 cases. The X-ray picture showed narrow intervertebral space in 5 cases, compressed body of vertebra in 7 cases, and destroyed 2 consecutive vertebra and its sclerotin was conduplicate in 1 case. All cases were abscess in major psoas muscle. The CT showed destruction of bone, abscess-formation and dead bone in body of vertebra of 16 cases. The abscess were found in vertebral canal in 5 cases and dura mater of spinal cord and spinal nerve root crushed in 2 cases. The MRI showed destruction of bone, abscess-formation and hibateral abscess in major psoas muscle in 11 cases. The abscess were found in vertebral canal and dura mater of spinal cord and spinal nerve root crushed in 6 cases. The therapy of pasid was treated after operation in all the cases. RESULTS: Incision healed by first intention in 16 cases; and disruption of wound occurred and healing was achieved after symptomatic treatment in 1 case. Sixteen cases were followed up 2-5 years (29 months on average). Among all the cases, anaesthesia in double thigh was found in 3 cases, adynamia of dorsiflexion in foot in 1 case, gatism in 1 case; after 2 weeks the symptoms were vanished. Indirect hernia of fold inguen were found in 1 case after 2 years, and the patient refused operation for age and was no longer followed up. Fuzzy, exsic and acerb in eyes were found in 6 cases, hearing disturbance were found in 2 cases, and symptoms were vanished after medication adjustment. Low-grade fever and lumbar myalgia were found in 1 case and cured after staying in bed and medication adjustment. All ESR were normal, synostosis of lumbosacral vertebral body was found in 13 cases, kyphosis in 1 case. CONCLUSION: Internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement is safe and available way for the treatment of tuberculosis of lumbosacral vertebral body, it can save the times of operation, shorten period and enhance effect of treatment.