一期前路病灶清除植骨融合内固定治疗腰骶椎结核  

The outcome of allograft and anterior instrumentation in the treatment of lumbosacral junction tuberculosis

作　　者：许建中[1] 张泽华[1] 周强[1] 谢肇[1] 何清义[1] 代飞[1] 

机构地区：[1]第三军医大学西南医院骨科,重庆市400038

出　　处：《中国脊柱脊髓杂志》2006年第12期897-900,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨经腹腔前入路一期病灶清除、同种异体髂骨移植、内固定治疗腰骶椎结核的效果。方法:对10例L5～S1椎体结核患者采用经腹腔入路显露腰骶椎,彻底清除病灶后用2块同种异体髂骨块平行椎间植骨,腰骶椎前方自锁钛板固定;术后常规支持和抗结核治疗,并定期(术后1、3、6、9、12个月,以后每6个月一次)随访,观察血沉变化,摄X线平片、CT三维重建评估结核活动、骨块融合和畸形矫正情况。结果:术中无大血管、神经、输尿管损伤,随访12～26个月,平均19个月,结核病变无复发,无结核性腹膜炎、勃起功能障碍、逆行射精等并发症发生,根据Bridwell标准,9例患者获Ⅰ级骨性愈合,1例为Ⅱ级骨性愈合,愈合时间9～12个月,腰骶角矫正无明显丢失。结论:经腹腔前方入路暴露腰骶椎结核病灶充分、安全,病灶清除后行同种异体髂骨块椎间植骨、腰骶椎前方自锁钢板固定可有效重建腰骶段的稳定性。Objective：To investigate the outcome of the patients with lumbosacral junction tuberculosis who underwent single stage radical debridement and reconstruction with bone allografi and anterior instrumentation via transperitoneal approach.Method：The lumbosacral junction was exposed adequately via anterior midline transperitoneal approach in 10 patients,radical debridement was performed,then two parallel tricortical iliae crest bone allografts were placed and anterior fixation was done to reconstruct the anterior column.All the patients were treated by antituberculous chemotherapy for 12 months after the operation,and followed up regularly in one month,and every 3 months until a year,then at intervals of half a year.The clinical status, ESR,roentgenogram and 3D-CT were concerned to estimate the progress of tuberculosis.Rradiographs were analyzed before surgery,immediately after surgery,and at the final follow-up examination to assess the result of anterior fusion and maintenance of correction.Result：There was no injury of blood vessel,ureter or cauda equina during the surgery.The mean follow-up period was 19 months（range 12-26 months）,no obvious loss of deformity correction was observed.According to Bridwell criteria,grade Ⅰ bony fusion was obtained in 9 patients and grade Ⅱ in another in 9-12 months.There was no recurrence,no tuberculous peritonitis,and no incidence of impotence or retrograde ejaculation in any of these patients.Conclusion：The midline transperitoneal approach can provide direct and safe access to the lesions.Two parallel structural lilac crest allografts and anterior instrumentation could work effectively to stablize the lumbosacral junction.

关 键 词：腰骶椎结核 前入路 内固定 

分 类 号：R529.2[医药卫生—内科学]