椎间隙入路行病灶清除、植骨及内固定治疗腰骶椎结核的疗效探讨  

Clinical pedicle internal fixation combined with debridement and bone graft through intervertebral approach as treatment of segmental lumbosacral vertebral tuberculosis

作　　者：邱南海[1] 王力[1] 苗瑞瑞[1] 薛海滨[2] 

机构地区：[1]天津市海河医院骨科,300350 [2]中国人民解放军第309医院骨科

出　　处：《天津医药》2015年第12期1440-1443,共4页Tianjin Medical Journal

基　　金：天津市卫生局局级课题(2014KZ037)

摘　　要：目的探讨后路经椎间隙人路行病灶清除、植骨及椎弓根钉系统内固定治疗单节段及多节段腰骶椎结核的疗效。方法 37例以单节段及多节段椎体破坏的腰骶椎结核患者均行后路经椎间隙病灶清除,椎弓根钉系统内固定,椎间隙内植骨治疗腰骶椎结核。术后行X线片、CT、MRI观察病灶愈合进程,下腰椎曲度,植骨融合情况和内固定稳定性情况。结果 34例患者均一期愈合,其中4例术中神经根牵拉伤,术后3个月恢复尚好,症状消失。另3例患者伤口出现窦道,其中有2例经过调整抗结核药物治疗及换药后均愈合,1例出现窦道后调整抗结核药清创后二期愈合,术后X线、CT及MRI示植骨处骨性融合尚好,椎体高度恢复,无后凸畸形,无内固定松动、断钉等。结论后路椎间隙人路行病灶清除、植骨及内固定治疗单节段及多节段椎体破坏较轻,手术创伤小,植骨融合尚好,内固定牢固,治疗效果满意。Objective To discuss and observe the clinical effect of intervertebral pedicle internal fixation and debridement combined with bone graft through posterior approach/trans-intervertebral space approach on the treatment of uni/multi-segmental lumbosacral vertebral tuberculosis （TB）. Methods A cohort of 37 patients, with single or multiple segmental vertebral destruction due to TB, were treated by trans-intervertebral debridement, posterior pedicle screw system internal fixation and intervertebral bone graft. All patients underwent X-ray,CT and MRI examination to observe the combination treatment effect. Results Most patients （n=34） enjoyed primary healing, in which include only 4 cases that presented symptom of nerve root stretch injury during operation but all recovered after 3 months. Other 3 patients underwent secondary healing due to sinus but two were rectifying with anti-TB therapy and wound dressing. The other 1 case suffered from sinus tract was healed through second debridement and rectifying therapy. X-ray, CT and MR at 6 months after operation indicated that all patients present great graft osseous fusion, good recovering of height of vertebral body without kyphosis deformity nor internal fixation loosening nor screw breakage. Conclusion Intervertebral pedicle internal fixation and debridement combined with bone graft through posterior approach/trans-intervertebral space approach is with minimum invasion but good graft fusion effects, harder fixation and satisfactory clinical effects in the treatment of uni/multi-segmental lumbosacral vertebral tuberculosis.

关 键 词：手术后并发症 椎间隙入路 腰骶椎结核 预后 

分 类 号：R529.2[医药卫生—内科学] R681.53[医药卫生—临床医学]