一期后路内固定、前路病灶清除植骨融合治疗腰骶段脊柱结核  

Treatment of Lumbosacral Tuberculosis by posterior internal fixation and anterior radical eradication bone graft fusion at one-stage

作　　者：王锡阳[1] 李洪波[1] 李伟伟[1] 葛磊[1] 魏伟强[1] 庞晓阳[1] 周炳炎[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,湖南长沙410008

出　　处：《中国现代医学杂志》2010年第24期3809-3812,3815,共5页China Journal of Modern Medicine

基　　金：湖南省自然科学基金课题(No:08JJ5013)

摘　　要：目的探讨一期后路内固定、前路病灶清除植骨融合治疗腰骶段脊柱结核的可行性、疗效及应用指征。方法回顾性研究2005年1月-2008年8月行一期后路内固定、前路病灶清除植骨融合术治疗的腰骶段脊柱结核23例。对比研究患者手术前后的腰骶角、椎间隙高度、血沉、C反应蛋白及神经功能ASIA分级的变化情况。结果随访6-42个月,平均26个月,23例患者均无严重并发症发生及结核复发,至末次随访时,所有植骨均获骨性融合,无内固定松动及断裂现象出现。患者的腰骶角由术前的（18.8°±4.2°）（10.5°~26.6°）矫正为术后的（27.1°±3.8°）（20.6°~34.5°）,术后的腰骶角较术前明显增大（P〈0.05）;椎间隙高度由术前的（7.9±0.4）mm（6.8~9.2）mm撑开为术后的（10.4±0.5）mm（8.9~11.3 mm）,术后的椎间隙高度较术前明显增高（P〈0.05）;ESR由术前的（40.8±10.2）mm/h下降为术后的（28.6±6.9）mm/h,至末次随访时继续下降为（10.0±2.1）mm/h,其变化有统计学意义（P〈0.05）;CRP由术前的（16.2±4.0）mg/L下降为术后的（11.5±2.3mg/L）,至末次随访时继续下降为（1.9±1.1）mg/L,其变化具有统计学意义（P〈0.05）。脊髓损伤ASIA分级术前有障碍者20例,术后19例改善明显。结论一期后路内固定、前路病灶清除植骨融合术能彻底清除结核病灶,显著改善结核中毒症状,有效地维持脊柱的稳定性,植骨融合可靠,卧床时间短,是一种治疗腰骶段脊柱结核的有效方法。【Objective】To investigate the feasibility,therapeutic efficacy and clinical indication of one-stage posterior internal fixation,anterior radical eradication,bone graft fusion in the treatment of lumbosacral tuberculosis.【Methods】Twenty-three cases with tuberculosis of lumbosacral spine were treated by one-stage posterior internal fixation,anterior radical eradication,bone graft fusion from January 2005 to August 2008.We comparatively studied the change of lumbosacral angle,intervertebral space altitude,ESR,CRP preoperatively and postoperatively.【Results】All cases were followed up for 6~42 months（average 26 months） During the period of follow-up,there was no severe complication found or tuberculosis recured.At the final follow-up,all cases had achieved solid bone fusion and there was no internal fixation lost or fratured.The lumbosacral angle of the postoperative was bigger than the preoperative（P〈0.05）.The intervertebral space altitude of the postoperative was higher than the preoperative（P〈0.05）.The value of ESR degraded from（40.8±10.2） mm/h preoperatively to（28.6±6.9） mm/h postoperatively and（10.0±2.1） mm/h at the final follow-up.Through statistic analysing,the change of ESR＇ value between postoperative and preoperative,the final follow-up is significant（P〈0.05）.The value of CRP degraded from（16.2±4.0） mg/L preoperatively to（11.5±2.3） mg/L postoperatively and（1.9±1.1） mg/L at the final follow-up.Via statistic analyzing,the change of CRP＇ value between postoperative and preoperative,the final follow-up is significant（P〈0.05）.According to the grade of ASIA,there were 20 cases of neurological function deficiency preoperatively,19 cases of them had conspicuously improved after the operation.【Conclusion】One-stage posterior internal fixation,anterior radical eradication,bone graft fusion can significantly improve the clinical symptoms,effectively rebuild the stability of the spine,definitely fast the bone graft fusion and absolutely shorten

关 键 词：脊柱结核 腰骶段 后路内固定 前路病灶清除 植骨 

分 类 号：R681.57[医药卫生—骨科学]