一期后路病灶清除、椎间打压植骨单节段固定治疗单节段腰椎结核

目的:探讨一期后路病灶清除、椎间打压植骨单节段固定治疗单节段腰椎结核的可行性及临床疗效。方法:回顾性研究2011年12月至2015年12月收集的28例单节段腰椎结核患者。年龄29~72(50.9±11.7)岁;术前病变节段Cobb角为13°~25°(16.6±3.0)°。术前ASIA神经功能分级:B级1例,C级2例,D级16例,E级9例。均采用一期后路病灶清除、椎间打压植骨单节段固定手术治疗。结果:所有病例术后随访42~60(50.5±5.5)个月,术后未发生严重并发症。术后Cobb角为5°~12°(8.1±1.6)°,末次随访为7°~12°(9.4±1.4)°,较术前得到显著改善(P<0.05)。至末次随访,根据ASIA分级,1例由B级恢复至D级,2例由C级恢复至E级,16例由D级恢复至E级。视觉模拟评分法(VAS评分)均较术前得到明显改善(P<0.05)。所有患者均在术后6~15(9.4±2.5)个月达到植骨融合。结论:对于符合手术适应证的单节段腰椎结核的患者,一期后路病灶清除、椎间打压植骨单节段固定手术方式安全有效且并发症少,患者术后生活质量得到提高。

One-stage posterior debridement,compact bone grafting and posterior single-segment fixation for mono-segmental lumbar tuberculosis

Objective: To study the feasibility and clinical effect of one-stage posterior debridement, compact bone graft ing and posterior single-segment fixation for mono-segmental lumbar tuberculosis. Methods: Twenty-eight patients with mono-segmental lumbar tuberculosis collected from December 2011 to December 2015 were studied retrospectively. The age ranged from 29 to 72 years with average years of 50.9±11.7, and the Cobb angle of preoperative lesion segment was 13°–25°(16.6±3.0)°. Preoperative ASIA nerve function classification: grade B in 1 case, grade C in 2 cases, grade D in 16 cases, grade E in 9 cases. All patients were treated with one-stage posterior debridement, compact bone graft ing and posterior single-segment fixation. Result: All patients were followed up for 42 to 60 months, with an average of(50.5±5.5) months, and no serious complications occurred. Th e Cobb angle aft er operation was 5°–12°, with an average of(8.1±1.6)°, and the last follow-up was 7°–12°, with an average of(9.4±1.4)°, which was significantly improved compared with that before the operation(P<0.05). At the last followup, according to ASIA grade, 1 case recovered from grade B to grade D, 2 cases from grade C to grade E, and 16 cases from grade D to grade E. Th e visual simulation score(VAS) was significantly improved compared with that before the operation(P<0.05). All patients achieved bone graft fusion in 6 to 15 months aft er the operation, with an average of(9.4±2.5) months. Conclusion: Th e one-stage posterior debridement, compact bone graft ing and posterior single-segment fixation is safe and effective with few complications, and the postoperative quality of life of patients is improved for patients with mono-segmental lumbar tuberculosis who meet the indications for surgery.