直接外侧椎间植骨融合联合后路经皮螺钉固定治疗腰椎结核

目的:探讨直接外侧椎间植骨融合联合后路经皮螺钉固定治疗腰椎结核的临床疗效及优越性.方法:对2013年6月至2016年8月采用手术治疗的83例腰椎结核患者的临床资料进行回顾性分析,其中男55例,女28例;年龄27～72(49.5±13.5)岁.83例患者根据术式不同分为两组,其中A组35例,行直接外侧椎间植骨融合联合后路...

Minimally invasive direct lateral approach debridement,interbody bone grafting,and interbody fusion combined with posterior percutaneous pedicle screw fixation for lumbar spinal tuberculosis

Objective: To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.Methods: From June 2013 to August 2016,the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed,including 55 males and 28 females,aged from 27 to 72(49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods,35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation,regular quadruple antituberculosis drugs were continued for 18 months. The operation time,intraoperative blood loss,hospital stay,bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain,Oswestry Disability Index (ODI),sagittal Cobb angle,erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.Result: The operation was successfully completed in both groups,and the operation mode was not changed during operation. The operation time,intraoperative blood loss and hospital stay were (149.4±13.3) min,(354.3±69.0) ml,(9.4±1.6) d in group A and(116.8±10.0) min,(721.9±172.3) ml,(11.8±1.7) d in group B,respectively,with significant difference between the two groups(P<0.05). The follow-up time was (24.2±5.1) months in group A and (24.0±5.0) months in group B,there was no significant difference between two groups (P>0.05). At the follow-up of 4 months after operation,one patient in group A was found to have enlarged psoas major abscess on the contralateral side,and was cured after secondary operation. No sinus formation,cerebrospinal fluid leakage,internal fixation loosening,fracture or distal junction kyphosis were found during follow-up. The fusion time was (5.1±1.6) months in group A and(5.1±1.7) months in group B,there was no significant difference between two groups(P>0.05). The VAS,ODI score,sagittal Cobb angle,ESR and CRP value of the lesion segment at the last follow-up of the two groups were significantly improved(P<0.05),but there was no significant difference between two groups (P>0.05).Conclusion: The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay,which is conducive to early rehabilitation of patients.