侧前方入路一期病灶清除植骨内固定治疗腰骶段结核

目的:探讨侧前方入路一期病灶清除植骨内固定手术治疗腰骶段结核的效果.方法:2005年1月～2007年1月采用侧前方入路行一期病灶清除、减压及植骨融合内固定术治疗腰骶段结核患者24例,男17例,女7例,年龄17～58岁.平均35.8岁.L4～L5 8例,L5 5例,L5～S1 8例,L4～S1 3例.神经功能按Frankel分级.B级1例,C级3例,D级2例,E级18例.术前腰骶角为19°±3.5°.结果:所有患者均能耐受手术,术中显露清楚,病灶清除彻底.手术时间120～180rain,平均150min;术中出血量500～900ml,平均700ml.无血管、神经及输尿管损伤等手术并发症发生.术后2周患者即可佩戴支具站立及下地行走.随访24～36个月,平均29个月,椎间植骨均获骨性融合,融合平均时间为7.8个月.末次随访时,6例术前合并神经功能损害患者中,1例B级恢复到D级,1例C级恢复到D级,2例C级恢复到E级,2例D级恢复到E级;腰骶角为26°±6.5°;结核病灶无复发,无断钉及内固定松动发生.结论:经侧前方入路一期病灶清除植骨内固定手术是治疗腰骶段结核的有效方法,具有矫正畸形、稳定脊柱、预防植骨块移位、术后患者可早期下地活动等优点.

One-stage anterolateral debridement,allograft and internal fixation for lumbosacral tuberculosis

Objective:To investigate the clinical efficacy of one-stage anterolateral debridement,allograft and internal fixation as an alternative treatment for lumbosacral tuberculosis.Method: From January 2005 to January 2007,24 patients with lumbosacral tuberculosis underwent one-stage anterolateral debridement.allograft and internal fixation.There were 17 males and 7 females with the average age of 35.8 years-old (range, 17 to 58 years-old).L4-L5 was involved in 8 patients,L5 in 5 patients,L5-S1 in 8 patients and L4-S1 in 3 pa-tients. 1 patient was classified as Frankel grade B,3 cases as grade C,2 cases as grade D and 18 cases as grade E.The mean preoperative lumbosacral angle was 19°±3.5°.Result:All patients underwent surgery successfully with lesion being removed completely .The average operating time was 150min (range, 120-180min) with the mean intraoperative blood loss of 700ml (range,500-900ml).No postoperative complication was noted. All patients recovered to be able to mobile in 2 weeks after operation with the protection of brace.All patients were followed up for 24-36 months (average, 29 months). At final follow-up, of the six patients with neurological deficit, 1 patient of Frankel grade B improved to grade D, 1 patient of grade C improved to grade D,2 patients of grade C improved to grade E and 2 patients of grade D improved to grade E.The mean postoperative lumbosacral angle was 26°±6.5°.No neurovascular injury,instrument failure and tuberculosis recurrence was noted.Bone union was observed in all cases with the average time of 7.8 months.Conclusion: Anterolateral debridement.allograft and internal fixation is effective to treat lumbosacral tuberculosis,which can ensure satisfactory deformity correction,spinal stability reconstruction,avoidance of bone graft displacement and early mobility after operation.