一期前路病灶清除植骨重建钛板内固定术治疗腰骶段脊柱结核

目的 探讨一期前路结核病灶清除植骨重建钛板内固定治疗腰骶段脊柱结核的临床疗效。方法 回顾性分析 2011年8月—2014 年8月南华大学附属第一医院脊柱外科收治的30例腰骶段脊柱结核患者的临床资料,其中男17例,女13例;年龄27~65岁,平均37.5岁;L₅～S₁节段病变。术前常规抗结核治疗2～3周,待全身状态改善后均行一期前路结核病灶清除椎间植骨融合重建钛板内固定手术,术后继续系统常规抗结核治疗12～18个月。分析术前、术后3个月及末次随访时红细胞沉降率、C反应蛋白、VAS评分以及ODI。结果 术后30例患者均获随访12～36个月,平均18个月。末次随访时患者均未出现结核复发、下肢放射痛及麻木症状。术前、术后3个月及末次随访时VAS评分分别为(7.8±1.7)、(1.7±0.6)、(1.5±0.5)分,ODI分别为71.20%±18.24%、13.41%±5.82%、10.22%±4.28%,红细胞沉降率分别为(37.8±15.2)、(11.6±3.7)、(10.3±3.3)mm/1 h,C反应蛋白分别为(26.4±8.2)、(6.8±2.9)、(6.4±2.1) mg/L。术后3个月及末次随访时VAS评分和ODI、红细胞沉降率、C反应蛋白与术前比较,差异均有统计学意义(P值均＜0.01),但上述观察指标在术后3个月与末次随访时比较,差异均无统计学意义(P值均>0.05)。结论 在全身标准化抗结核治疗基础上,一期前路结核病灶清除植骨融合重建钛板内固定手术治疗腰骶段脊柱结核,能够直接安全进入病灶,彻底清除病灶并重建腰骶椎的稳定性,从而取得良好的疗效。

Clinical efficacy of one-stage anterior debridement,bone graft and reconstruction titanium plate internal fixation in treating lumbosacral spinal tuberculosis

Objective To evaluate clinical outcomes following one-stage anterior radical debridement, interbody fusion, and reconstruction titanium plate internal fixation for the treatment of lumbosacral spinal tuberculosis. Methods The clinical data of 30 patients (17 males and 13 females, aged range from 27 to 65 years, mean 37.5 years) with tuberculosis of the lumbosacral segments(including L₅-S₁)who were treated with anterior radical debridement, autologous iliac bone graft,and internal fixation with reconstruction titanium plate at Department of Spinal Surgery of the First Affiliated Hospital of University of South China from August 2011 to August 2014 were retrospectively reviewed. All patients routinely received antitubercular drugs for 2 to 3 weeks before operation. Operation was performed when the general condition improved. All patients were systematically and routinely treated with antituberculous drug for 12-18 months after operation. The preoperative, 3 months after operation, last follow up erythrocyte sedimentation rate(ESR), C reactive protein(CRP), visual analog scale (VAS) , as well as Oswestry disability index (ODI) were analyzed. Results Thirty patients were followed up for 12-36 months, mean 18 months. At last follow-up, no lower limb radiation pain and tuberculosis recurrence were found in all cases. The VAS scores were significantly decreased from 7.8±1.7 at preoperation to 1.7±0.6 at 3 months after operation, and 1.5±0.5 at last follow-up(all P values<0.01). The ODI were significantly decreased from 71.20%±18.24% at preoperation to 13.41%±5.82% at 3 months after operation and 10.22%±4.28% at last follow-up (all P values<0.01). The ESR were significantly decreased from (37.8±15.2) mm/1 h at preoperation to (11.6±3.7)mm/1 h at 3 months after operation and (10.3± 3.3)mm/1 h at last follow-up(all P values<0.01), and the CRP were reduced from (26.4±8.2) mg/L at preoperation to (6.8±2.9) mg/L at 3 months after operation and (6.4±2.1) mg/L at last follow-up(all P values<0.01), but no significant differences were found between VAS, ODI, ESR, CRP at 3 months after operation and last follow-up (all P values>0.05). Conclusions Based on systemic and routine antituberculosis treatment, the surgical treatment of lumbosacral spinal tuberculosis with one-stage anterior debridement, bone graft and reconstruction titanium plate internal fixation have a direct and safe access to lesions of lumbosacral tuberculosis, and eradicate tuberculosis kitchen, reconstruct spinal stability and achieve good clinical outcome.