前路一期病灶清除植骨U型钛板内固定治疗腰骶段结核  

Anterior primary debridement,bone grafting and internal fixation for lumbosacral spinal tuberculosis

作　　者：罗鹏[1] 方忠[2] 李光辉[2] 熊伟[2] 李锋[2] 李红刚[2] 

机构地区：[1]湖北省新华医院,湖北武汉430015 [2]华中科技大学同济医学院附属同济医院,湖北武汉430030

出　　处：《安徽医药》2011年第8期993-995,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的总结经腰骶椎前路一期病灶清除植骨U型钛板内固定治疗腰骶段结核的临床疗效。方法 2005年1月～2009年9月,采用经腰骶椎前路一期病灶清除植骨U型钛板内固定治疗腰骶段结核21例,其中男12例,女9例。19例有不同程度腰骶部持续疼痛,11例伴下肢放射痛,8例单侧下肢肌力、感觉减退,2例伴鞍区麻木。术前使用四联抗结核2～4周,待结核中毒症状改善或血沉呈下降后行手术治疗。结果 21例均获随访,随访时间11～38个月,平均20个月。12例男性患者均无勃起功能障碍、逆行射精等症状。下肢放射性疼痛、鞍区麻木症状消失。2例轻度腰骶部疼痛,对症处理后疼痛缓解。术后6个月均获骨性融合,手术治愈率90.4%。结论腰骶段椎体前方入路一期病灶清除植骨U型钛板内固定治疗腰骶段结核,可重建脊柱稳定性,获得良好的骨性融合。Aim To evaluate the clinical outcomes of primary anterior radical debridement,bone autograft,and internal fixation in treating tuberculosis of the lumbosacral segments.Methods From January 2005 to September 2009,21 patients with tuberculosis of the lumbosacral segments were treated with anterior radical debridement,autologous iliac bone graft,and internal fixation with titanium plate,including 12 males and 9 females.All patients experienced toxic symptoms of the tuberculosis and 19 cases experienced various degrees of pain in the lumbosacral area,8 cases unilateral lower limb muscle,feel drops,and 2 cases saddle area anaesthesia.All cases received four antitubercular drugs for 2 to 4 weeks.Operation was performed when the toxic symptom of the tuberculosis was under control and ESR was decreased.Results All cases were followed up for 11～38 months（average 20 months）.No postoperative erectile dysfunction and retrograde ejaculation occurred in the 12 male patients.The radical pain in the lower extremities and the saddle area anaesthesia disappeared.Two patients had mild pain in the lumbosacral area,and the pain was eliminated after symptomatic treatment.All patients achieved bony fusion 6 months after operation.The curativerate was 90.4 percent.Conclusion The surgical treatment of tuberculosis of the lumbosacral segments with primary anterior focus debridement,bone autograft,and titanium plate fixation can reconstruct spinal stability and achieve satisfying bony fusion.

关 键 词：腰骶段结核 病灶清除 植骨 内固定 

分 类 号：R687.3[医药卫生—骨科学]