单纯一期后路手术联合多枚分网异形钛网技术治疗腰骶段脊柱结核

目的：探讨椎体间多枚分网的异形钛网植骨技术应用于单纯一期后路手术治疗腰骶段(腰5/骶1)脊柱结核的安全性及临床疗效。方法：自2009年7月至2012年6月，采用多枚分网异形钛网植骨技术一期后路手术治疗的腰骶段结核患者共25例。比较25例患者术前术后ASIA分级、腰骶角度、椎间隙高度、疼痛视觉模拟评分(visual analogue scale，VAS)、红细胞沉降率，并观察手术时间、术中失血量、植骨融合情况。结果：手术时间为90~180(128±24) min，术中失血量100~800(310±125) mL。术后随访24~59(43±7)个月。神经功能障碍的患者术后神经功能均有不同程度的改善；25例患者术后6个月红细胞沉降率均恢复正常；终末随访时腰骶角和椎间隙高度较术前明显增加(P<0.001)。术后2周患者VAS较术前降低；植骨融合时间为4~8(平均6)个月。术后1例患者伤口延迟愈合。无窦道形成和结核复发，亦无感染性脑脊髓膜炎和钛网沉降发生。结论：对于腰骶段结核患者，单纯一期后路病灶清除联合多枚分网异形钛网植骨手术是一种安全、有效的手术方式，且更好地重建脊柱前柱稳定性。

Multiple special formed titanium mesh cages in the treatment of lumbo-sacral spinal tuberculosis via posterior approach only

Objective: To determine the clinical efficacy and feasibility of multiple special formed titaniummesh cages (TMCs) to treat lumbo-sacral spinal tuberculosis via posterior approach.Methods: From July, 2007 to June, 2013, 25 patients with lumbo-sacral spinal tuberculosisunderwent one-stage posterior debridement, internal fi xation, and interbody fusion using multiplespecial formed titanium meshes. We compared the parameters as follow: the pre- and post-operativeAmerican Spinal Injury Association (ASIA) score, lumbo-sacral angle, the height of intervertebralspace, visual analogue scale (VAS), and erythrocyte sedimentation rate (ESR), and observedoperation time, intraoperative blood loss, and time of bone graft fusion.Results: Operation time ranged from 90 to 180 min, (128±24) min in average. Blood loss in theoperation ranged from 100 to 800 mL, (310±125) mL in average. The patients were followed up for24 to 59 months, (43±7) months in average. One patient delayed healing of wound. ASIA score wasimproved in a certain degree in patients with neurological dysfunctions. The lumbo-sacral angle andthe height of intervertebral space in the post-operation were significantly higher than those in the preoperation(P<0.001). VAS was reduced obviously after 2 weeks of operation. The ESR recovered tothe normal level 6 months after operation in all the patients. Solid fusion was achieved within 4 to 8months, 6 months in average. No sinus tract, cerebrospinal meningitis, tuberculosis recurrence andtitanium mesh subsidence were found.Conclusion: For lumbo-sacral tuberculosis, multiple special formed titanium mesh cages viaposterior approach is safe and effective, which is good to the stability in spine reconstruction.