后路椎弓根系统内固定并髂骨植骨修复多节段腰骶椎结核:重建稳定的腰骶段  

Posterior pedicle screws with iliac bone grafts to repair multi-segmental lumbosacral tuberculosis: to reconstruct lumbosacral stability

作　　者：余铭[1,2] 邱南海[2] 

机构地区：[1]天津医科大学,天津市300350 [2]天津市海河医院骨科,天津市300350

出　　处：《中国组织工程研究》2015年第9期1377-1381,共5页Chinese Journal of Tissue Engineering Research

基　　金：天津市卫生局科技基金项目(2014KZ037)~~

摘　　要：背景:多节椎体破坏的腰骶椎结核在治疗上比较复杂,除了考虑病灶清除,解除脊髓压迫外,恢复脊柱椎体的高度及脊柱的稳定性也是必要的。目的:探讨后路椎弓根系统内固定前路一期病灶清除自体髂骨植骨修复多节段腰骶部结核的效果。方法:选择2005年3月至2012年12月收治的多节段腰骶椎脊柱结核患者25例,病变节段位于L2-S2,经正规抗结核治疗2-4周后,行一期后路椎弓根系统内固定、前路病灶清除自体髂骨植骨治疗。修复后定期复查X射线片与CT扫描,评估骨块融合和畸形矫正情况,并记录不良事件及材料宿主反应。结果与结论:修复后进行了平均16个月的随访,23例切口全部愈合,2例切口二期愈合,无窦道形成,术后所有患者腰腿痛均消失;随访期间植骨块无滑脱移位,无断钉断棒,6个月内均出现骨性融合,术后1年结核病灶无复发,血沉正常,X射线片显示病变椎体已骨性愈合。术后腰骶角为16°-36°,平均26°;末次随访时为15°-30°,平均20°。提示:一期病灶清除多节段腰骶骨结核,并同期行后路椎弓根系统内固定完成后凸畸形矫正,可重建稳定的腰骶段,恢复躯体矢面平衡,取自体髂骨植骨能提高融合率,效果满意。BACKGROUND：The treatment of lumbosacral tuberculosis with multi-segmental vertebral destruction is complex. Besides, debridement and relief of spinal cord compression, it is necessary to restore spine vertebral body height and stability of the spine. OBJECTIVE：To investigate the surgical treatment effect of multi-segmental lumbosacral tuberculosis by posterior vertebral pedicle fixation and anterior debridement with autologous iliac bone graft. METHODS：A total of 25 cases of L 2-S 2 vertebral tuberculosis with various degrees of damage, who were treated from March 2005 to December 2012, were selected in this study. After regular anti-tuberculosis treatment for 2-4 weeks, first-phase posterior pedicle screw fixation with anterior debridement and autologous iliac bone graft was performed. Postoperative X-ray and CT scan were conducted to assess bone fusion and deformity correction. Adverse events and material host reaction were recorded. RESULTS AND CONCLUSION：After repair, average 16-month fol ow-up was performed. 23 cases of postoperative wound were total y healed, with 2 cases of incisions delaying healing, no sinus formation. After surgery, the lumbago and leg pain disappeared in al patients. During fol ow-up, graft displacement had no slippage, broken nails or broken rods. Within 6 months, bony fusion occurred. At 1 year after operation, there was＆nbsp;no recurrence of tuberculosis with normal erythrocyte sedimentation. X-ray films showed lesion vertebra turned out to be bony union. Postoperative lumbosacral angle was 16°-36°, averagely 26°, and 15°-30° during final fol ow-up, averagely 20°. These results confirmed that one-stage debridement for multi-segmental lumbosacral tuberculosis and concomitant posterior pedicle fixation system for kyphosis correction therapy, which could reconstruct lumbosacral stability, and restore sagittal plane balance. Autologous iliac bone graft improved fusion rate and obtained satisfactory outcomes.

关 键 词：植入物 脊柱植入物 腰骶椎结核 前后联合入路 内固定 病灶清除 植骨 

分 类 号：R318[医药卫生—生物医学工程]