一期经前路病灶清除、自体髂骨植骨内固定治疗腰骶椎结核

目的探讨前路一期病灶清除、自体髂骨植骨、单枚自锁钛板内固定治疗腰骶椎结核的临床疗效。方法采用经前方入路、2枚适宜大小的自体髂骨块移植植骨、单枚自锁钛板前方内固定治疗9例腰骶段结核患者,术前异烟肼、利福平、吡嗪酰胺、乙胺丁醇四联抗结核治疗至少2周,待ESR控制在35mm/1h以下、体温恢复正常后行手术治疗。结果患者均获得随访,时间12~68个月。末次随访时患者结核症状均消失、ESR恢复正常。腰骶角:术后24.3°~35.1°,末次随访时23.7°~34.0°。患者均获得Ⅰ级骨融合,未发生植骨块移位及钛板、螺钉松动或断裂。神经功能Frankel分级:1例C级恢复至D级,4例D级均恢复至E级。结论前路一期病灶清除、自体髂骨植骨、单枚自锁钛板内固定治疗腰骶椎结核安全、有效,骨融合良好,重建腰骶段稳定性,畸形矫正维持良好。

Clinical observation on primary anterior approach focus debridement and bone allograft in ;the treatment of tuberculosis of the lumbosacral junction

Objective To discuss the clinical effect of stageⅠfocal clearance through anterior approach, autologous iliac crest graft and single self-locked titanium plate internal fixation in the treatment of tuberculosis of lumbosacral junction. Methods Nine cases with lumbosacral tuberculosis were treated by two pieces of autologous iliac crest through anterior approach and a single self-locked titanium plate anterior internal fixation. Before operation, these pa-tients received the anti-TB quadruple therapy with the combined use of isoniazide, rifampicin, pyrazinamide and ethambutol for at least two weeks. Surgery was performed after ESR was controlled below 35mm/1h and the body tem-perature returned to normal. Results The patients was followed up for 12~68 months. All symptoms of TB disap-peared and ESR returned to normal at the latest follow-up. The postoperative lumbosacral angle was 24. 3°~35. 1°, while that at the latest follow-up was 23. 7°~34. 0°. All patients received gradeⅠbone fusion, with no migration of bone graft, or loosening or breakage of titanium plate or screw. One case of Frankel grade C recovered to grade D, four patients with Frankel grade D recovered to grade E. Conclusions StageⅠfocal clearance through anterior ap-proach, autologous iliac crest graft and a single self-locked titanium plate internal fixation are safe and effective for the treatment of tuberculosis of lumbosacral junction. This method can gain good bone fusion and maintain excellent recon-struction of lumbosacral stability and deformity correction.