侧卧位一期前后联合入路手术治疗腰骶段结核

目的 探讨侧卧位一期前后联合入路手术对于腰骶段结核治疗的独特优势.方法 2004年4月至2009年6月对15例腰骶段结核患者采用侧卧位一期前后联合入路病灶彻底清除重建术,其中男6例,女9例,平均48.9岁.病变累及:L3～4,5例,L4～5,5例,L5S1,2例,累及L4,1例,累及L5,2例;15例患者中有14例病变累及椎管且7例临床上有马尾神经受压表现.术后对患者的临床症状和影像学表现进行评估.结果 11例为右侧卧位,其余4例采用左侧卧位.15例患者手术时间230～380 min,平均280 min.术中出血1100～3000ml,平均1720 ml.复查影像学除有2例钛网轻度塌陷外,其余内植物无松动或移位.术前和术后腰骶段的前凸角度比较差异有统计学意义[(20±5)°比(31±5)°,P＜0.05].Kirkaldy-Willis分级评价结果满意为13例.结论 侧卧位一期前后联合入路治疗腰骶段结核可以达到病灶彻底清除,前后路协同,重建脊柱的目的同时避免了因体位变换的二次消毒,缩短手术时间,无需二期手术.此入路腰骶段结核手术治疗吸收了前路、后路和前后路二期手术入路各自的优点,而且弥补了它们的不足.

Abstract：

Objective To investigate the feasibility of a one-stage combined posterioanterior approaches for the treatment of lumbosacral tuberculous spondylitis with the patients lying in a lateral position. Methods A retrospective review was conducted for 15 patients with lumbosacral tuberculosis undergoing one-stage combined posterioanterior approaches for radical lesion resection and reconstruction. All patients were observed and evaluated by clinical and imaging studies. Results Operative posture: 11 cases for right side and 4 cases for left side. The mean operative duration was 280 min ( range :230 - 380 min) and the mean estimated volume of blood loss 1720 ml (range: 1100 -3000 ml). Imaging results: No recurrence of tuberculose focus was found until the last follow-up. Upon image reviewing, it showed no loosening or displacement except for two cases of slightly collapsed titanium mesh. Preoperative and postoperative changes in the degree of lumbar lordosis were statistically significant [( 20 ± 5 ) ° vs ( 31 ± 5 ) °, P ＜ 0. 05]. The Kirkaldy-Willis classification rating yielded satisfactory results for 13 cases. Conclusion The patients with lumbosacral tuberculosis undergoing one-stage combined posterioanterior approaches may achieve radical lesion resection, posterioanterior collaboration and reconstruction. It avoids a 2-stage operation, eliminates the need of changing a patient's body position with secondary sterilization and shortens the operative duration. Lumbosacral surgery for tuberculosis combines the respective advantages of anterior, posterior and combined posterioanterior approaches and yet makes up for their deficiencies.

Lateral position one-stage combined posterioanterior approaches for the treatment of lumbosacral tuberculous spondylitis

Objective To investigate the feasibility of a one-stage combined posterioanterior approaches for the treatment of lumbosacral tuberculous spondylitis with the patients lying in a lateral position. Methods A retrospective review was conducted for 15 patients with lumbosacral tuberculosis undergoing one-stage combined posterioanterior approaches for radical lesion resection and reconstruction. All patients were observed and evaluated by clinical and imaging studies. Results Operative posture: 11 cases for right side and 4 cases for left side. The mean operative duration was 280 min ( range :230 - 380 min) and the mean estimated volume of blood loss 1720 ml (range: 1100 -3000 ml). Imaging results: No recurrence of tuberculose focus was found until the last follow-up. Upon image reviewing, it showed no loosening or displacement except for two cases of slightly collapsed titanium mesh. Preoperative and postoperative changes in the degree of lumbar lordosis were statistically significant [( 20 ± 5 ) ° vs ( 31 ± 5 ) °, P ＜ 0. 05]. The Kirkaldy-Willis classification rating yielded satisfactory results for 13 cases. Conclusion The patients with lumbosacral tuberculosis undergoing one-stage combined posterioanterior approaches may achieve radical lesion resection, posterioanterior collaboration and reconstruction. It avoids a 2-stage operation, eliminates the need of changing a patient's body position with secondary sterilization and shortens the operative duration. Lumbosacral surgery for tuberculosis combines the respective advantages of anterior, posterior and combined posterioanterior approaches and yet makes up for their deficiencies.