一期后路病灶清除楔形截骨联合椎体间颗粒骨植骨融合术治疗伴严重后凸畸形的活动期胸腰椎结核

目的探讨一期后路病灶清除楔形截骨联合椎体间颗粒骨植骨融合术治疗伴严重后凸畸形的活动期胸腰椎结核的临床疗效。方法回顾性分析在山西医科大学第二医院接受一期后路病灶清除楔形截骨联合椎体间颗粒骨植骨融合术治疗的30例胸腰椎结核患者的临床资料。术前及末次随访时采用疼痛视觉模拟量表(VAS)评分评估疼痛程度,采用美国脊髓损伤协会(ASIA)分级评估脊髓损伤程度;术后每3个月行X线复查,评估骨融合情况和后凸畸形矫正情况;末次随访时采用Kirkaldy-Willis功能评分评估综合疗效。结果所有手术顺利完成,所有患者随访(24±5)个月,骨融合时间为(6.3±2.3)个月,融合率为100%。ASIA分级术前B级1例、C级2例术后恢复至D级;术前D级14例,术后12例恢复至E级,2例仍为D级;术前E级13例,术后仍为E级。后凸Cobb角术前为40.1°±8.1°,术后即刻为12.0°±7.0°,末次随访时为15.1°±6.9°,随访期间矫正角度丢失3.1°±1.4°,末次随访时后凸Cobb角与术前相比差异有统计学意义(P<0.05)。根据Kirkaldy-Willis功能评分标准,末次随访时综合疗效优22例、良6例、可2例,总优良率为93.33%。结论一期后路病灶清除楔形截骨联合椎体间颗粒骨植骨融合术治疗伴严重后凸畸形的活动期胸腰椎结核安全有效,但尚需更多的研究来验证其疗效,并得到确切的手术适应证。

One-stage posterior debridement, wedge osteotomy combined with interbody granule bone grafting and fusion for treatment of active thoracic and lumbar tuberculosis with severe kyphosis

Objective To investigate the clinical efficacy of one-stage posterior debridement,wedge osteotomy combined with interbody granule bone grafting and fusion in the treatment of active thoracic and lumbar tuberculosis with severe kyphosis. Methods The clinical data of 30 patients with thoracic and lumbar tuberculosis admitted to Second Hospital of Shanxi Medical University treated by one-stage posterior debridement,wedge osteotomy combined with interbody granule bone grafting and fusion were analyzed retrospectively. The visual analogue scale(VAS) score and American Spinal Injury Association(ASIA) grade were used to evaluate pain and spinal cord injury. X-ray examination was performed every 3 months to evaluate the bone fusion and kyphosis correction. Kirkaldy-Willis functional score was recorded at the final follow-up. Results All the operations were successfully completed. All the patients were followed up for (24±5)months. Bone fusion time was (6.3±2.3)months. The fusion rate was 100%. ASIA classification,grade B was seen in 1 case and grade C in 2 at pre-operation,all recovered to grade D at post-operation;grade D in 14 at pre-operation,recovered to grade E in 12 and remained grade D in 2 at post-operation;grade E in 13 at pre-operation remained grade E at post-operation. The kyphosis Cobb''s angle was 40.1°±8.1° at pre-operation,12.0°±7.0° at immediate post-operation,and 15.1°±6.9° at the final follow-up with a loss of 3.1°±1.4° during the follow-up period,showing significant difference between the pre-operation and final follow-up(P<0.05). Kirkaldy-Willis functional score showed excellent in 22 cases,good in 6 and fair in 2,and the excellent and good outcome rate was 93.33%. Conclusion One-stage posterior debridement,wedge osteotomy combined with interbody granule bone grafting and fusion is an effective and safe method in the treatment of active thoracic and lumbar tuberculosis with severe kyphosis. However,more research is needed to verify its clinical outcomes and seek out the exact surgical indications.