一期侧前路双钉棒系统固定治疗腰骶段脊柱结核  

Fusion with titanium mesh cage and internal fixation with double pedicle crew system to treat lumbosacral spinal tuberculosis by anterolateral approach in one stage

作　　者：杨寅[1,2] 张延平[2] 贺西京[1] 董军[1] 张春俊[2] 郭春阳[2] 付战利[2] 

机构地区：[1]西安交通大学第二附属医院骨科,710004 [2]西安市中心医院骨二科,710003

出　　处：《中华骨科杂志》2016年第4期208-214,共7页Chinese Journal of Orthopaedics

基　　金：陕西省科技统筹创新工程项目（2011KTCL03-17）

摘　　要：目的 探索一期侧前路病灶清除、钛笼植骨融合、双钉-棒系统内固定治疗腰骶段脊柱结核的方法.方法 回顾性分析2009年9月至2012年12月收治腰骶段脊柱结核8例患者的病历资料,男5例,女3例;年龄20～65岁,平均51.6岁.所有患者均有明显的持续性腰痛,伴单侧下肢放射痛4例,单侧下肢肌力、感觉减退者3例;5例伴有不同程度的低热,消瘦等结核中毒症状,均不伴有其他部位活动性结核.单纯L5椎体3例,L4、L5椎体4例,L5、S1椎体1例.术前给予正规抗痨治疗4周以上,采用侧前路经腹膜外游离髂总、髂动静脉,在其深面彻底清除病灶,钛笼植骨、双钉-棒系统内固定手术治疗.术后给予持续抗痨,预防感染,早期腰部保护下活动,定期复查等.结果 所有患者均顺利完成手术,手术时间180～360 min,平均225 min,出血量平均为624 ml,引流量平均约150 ml.术中无严重并发症发生.随访8～30个月,平均12个月.术后结核全部治愈,患者腰腿痛明显好转,原腰骶部结核未复发,融合内固定良好,功能恢复满意.植骨融合时间平均8.3个月,随访期间无钉棒折断、松动等并发症,无血管阻塞或出血等发生.结论 侧前路一次性彻底清除腰骶段结核病灶,同时可有效、可靠地行钛笼、双钉-棒内固定;在髂动静脉后面、腰骶椎前面安置钉棒,不会引起血管栓塞或磨破,是治疗严重腰骶段脊柱结核一种安全、有效的方法.Objective To explore a surgical method for the treatment of lumbosacral spinal tuberculosis by combination of one-stage focus debridement with anterolateral incision, bone graft fusion with titanium mesh cage and internal fixation with double pedicle crew system.Methods From Sep.2009 to Dec.2012, a total of 8 patients with lumbosacral spinal tuberculosis which included 5 cases of male, 3 cases of female.The age ranged from 20 to 65 years, with a mean of 51.6 years.All patients presented with persistent back pain, 4 patients with radiating pain of unilateral lower limb, 3 with weakness and numbness and 5 with constitutional symptoms including low-grade fever and weight loss.All patients were not associated with active tuberculosis in oth er parts of the body.The patients were given regular anti-TB treatment for at least 4 weeks.By anterolateral incision, common iliac and iliac arteries and veins were dissociated extraperitoneally.The focus was completely debrided through the inferior part of vessels.Then the bone graft fusion was performed with the titanium mesh cage and the internal fixation with a double pedicle crew system was accomplished.After the surgery, patients were treated with continuous anti-TB drugs and with antibiotics to prevent infection.Patients were allowed to move with the protection of waist early and regular follow-up.Results Operation time was 180-360 min, with an average of 225 min.Operative blood loss was 624 ml and drainage volume was 150 ml on average.All cases were cured after surgery.No severe complications were observed during the surgeries.After follow-up of 8 to 30 months （averaged 12months）, no recurrence of the tuberculosis was found.The lumbocrural pain improved in all the patients.Complications such as migration, loosening and breaking of the implants were not observed.The vertebral bodies were fused in all patients with an average time of 8.3 months.No case occurred angiemphraxis or internal bleeding.Conclusion The method debrids the focus of lumbosacral spinal tuberculosis

关 键 词：腰椎 骶骨 结核 脊柱 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]