手术治疗腰骶段脊柱结核的治疗体会

目的总结腰骶段脊柱结核手术治疗的经验。方法 2002年8月-2008年12月收治腰骶段脊柱结核31例,后路椎弓根螺钉固定植骨融合结合前路彻底病灶清除、植骨融合（即前后路联合手术）21例,后路椎弓根螺钉固定,经后方椎管病灶清除、自体髂骨植骨融合（即单纯后路手术）10例,所有患者均一期手术。结果术后随访6个月-5年,平均3.1年。①前后路联合手术21例,手术用时200-280m in,平均（220±18.3）m in,出血量400-600m l,平均（480±38.4）m l;术后切口均Ⅰ期愈合,椎间植骨平均在5个月融合,植骨融合率95.2%。②单纯后路手术10例,手术用时150-180m in,平均（170±14.6）m in,出血量300-500m l,平均（410±38.4）m l,8例切口Ⅰ期愈合,2例窦道形成,术后3个月窦道闭合;椎间植骨平均在5个月融合,植骨融合率90%。全组术后后凸成角0-4,°平均2°,无1例复发。结论手术治疗腰骶段脊柱结核应根据病损和脓肿的部位,具体分析。适当的手术入路有利于减少损伤、彻底病灶清除、重建脊柱的稳定性、提高植骨融合率、纠正和预防后凸畸形。

Surgical treatment for lumbarsacral junction tuberculosis

Objective To summarize surgical treatment for lumbarsacral junction tuberculosis.Methods 31 cases of the lumbarsacral junction tuberculosis were treated with surgical treatment in one stage between January 2002 and December 2008.21 cases were treated with combined anterior radical debridement and autograft and posterior instrumentation and fusion in one stage,10 cases were treated with posterior radical debridement,instrumentation and fusion in one stage.Resalts The mean intra-operative blood loss was 475（400~600）ml,the mean duration of surgery 220（200~280）minutes,all incisions were healed up primarily and the spinal fusion were achieved in 86.3% of the patients within average 5 months after operation in patients treated with combined surgery.The mean intra-operative blood loss was 410（300~500）ml,the mean duration of surgery 170（150~180）minutes,8 cases incisions were healed up primarily,2 cases sustained sinus after operation and healed up postoperatively at 3 month and the spinal fusion were achieved in 90% of the patients within average 5 momhs after operation in patiems treated with posterior approach surgery.The postopretive kyphosis was 0～4 degrees with mean of 2 degrees and there was no recurrence within follow-up period in all the patients.Conclusion Lumbarsacral junction tuberculosis should be treated by different approach based on the location of lesson and abscess.The appropriate approach can achieve a high satisfactory rate with radical debridement,reducing surgical injuries,restoring the spinal stability,providing early fusion,correcting the kyphosis and preventing progression of kyphosis.