前路病灶清除植骨并后路经椎弓根固定治疗腰骶部结核18例

目的采用前路病灶清除植骨并后路经椎弓根固定治疗腰骶部脊柱结核，探讨后路钉棒系统内固定的可行性及前路病灶清除植骨融合的可靠性。方法本组男12例，女6例；年龄32～54岁，平均42．3岁。18例均表现为持续的下腰痛，其中6例伴有单侧下肢痛，无明显潮热、盗汗等结核中毒症状。结核病灶累及L4～L59例，L5～S15例，L4～S14例。10例伴双侧腰大肌脓肿，5例伴单侧腰大肌脓肿，3例未见明显脓肿影。病灶破坏最严重处在L5椎体。3例CT检查提示，腰椎小关节增生内聚伴侧隐窝神经根管狭窄。术前常规抗痨治疗疗6～8周，常用链霉素、异烟肼、利福平和乙胺丁醇四联治疗，并加用氧氟沙星强化抗痨治疗1个月，每周复查血沉。待血沉控制在40mm／h左右，结核中毒症状有改善，体温低于37．5℃，营养不良基本纠正后进行手术治疗。所有患者均采用后路经椎弓根固定并前路病灶清除植骨融合术，其中有3例行侧椎管减压术。术后1～2周内采用异烟肼静脉给药，链霉素常规肌注，同时给予喹诺酮类药物以增强抗结核效果及预防混合感染，肛门排气、恢复进食后则加用利福平、乙胺丁醇口服给药，2周后改用原抗痨方案。结果本组18例获随访，随访时间12～36个月，平均20个月，按照结核治愈标准，所有随访患者结核症状消失，病灶治愈无复发。按Moon植骨成功后观察标准，本组病例植骨均愈合，愈合时间5～9个月，平均7．5个月。结论后路椎弓根固定稳定可靠，同时可行侧椎管减压、椎间植骨块加压固定有效避免植骨块松动。病椎椎弓根置人短螺钉可有效恢复脊柱正常序列，避免后期下腰痛的发生。

Debridement of the focus of infection through anterior approach and bone graft with pedicle screw-rod internal fixation through posterior approach combined for the treatment of tuberculosis lumbosacral spine

Objective To treat tuberculosis of lumbosacral spine with debridement of the focus of infection through anterior approach and bone graft combined with pedicle screw-rod internal fixation through posterior approach,so as to explore the feasibility of internal fixation with screw-rod system through posterior approach,and the necessity with debridement of the focus of tuberculosis through anterior approach and bone graft.Methods Among 18 patients in the study,12 patients were male and 6 patients were female,ra...