不同类型腰骶椎结核手术治疗方式的有效性和安全性研究  

Surgical strategies based on four clinical classifications of lumbosacral junction tuberculosis

作　　者：张泽华[1] 陈非凡[1] 李建华[1] 罗飞[1] 代飞[1] 侯天勇[1] 周强[1] 何清义[1] 许建中[1] 

机构地区：[1]第三军医大学西南医院骨科,重庆400038

出　　处：《中华骨科杂志》2016年第11期662-671,共10页Chinese Journal of Orthopaedics

基　　金：第三军医大学临床创新基金（SWH2011015）

摘　　要：目的采用回顾性研究评价4种不同术式治疗不同类型腰骶椎结核的有效性和安全性。方法2001至2013年手术治疗腰骶椎结核患者共79例，根据病变类型不同，选择不同的手术方式。一期前路手术45例，一期前后联合入路手术18例，一期后路手术10例，单纯病灶清除6例。术后联合抗结核药物治疗18个月，支具外固定6个月。对比分析手术时间、出血量、红细胞沉降率、疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry dis-ability index，ODI），摄X线片、三维CT观察术前腰骶角、术后及末次随访腰骶角，评估结核愈合、植骨融合和畸形矫正情况。结果随访时间18~42个月,平均23个月，椎间植骨均达到I级骨愈合，腰痛及放射痛均缓解，术中无大血管、神经、输尿管损伤，术后无结核性腹膜炎、勃起功能障碍、逆行射精等并发症。一期前路组、一期前后联合入路组、一期后路组、单纯病灶清除组的平均手术时间分别为（144.31±23.18）min、（444.72±141.63）min、（351.50±85.25）min、（90.00±29.66）min；平均出血量分别为（266.67±104.45）ml、（988.99±488.26）ml、（890.00±306.23）ml、（200.00±104.88）ml。术前平均VAS评分分别为（4.71±1.79）分、（5.22±1.48）分、（3.30±1.64）分、（2.50±1.52）分；末次随访时分别为（0.97±0.69）分、（0.89±0.68）分、（0.90±0.74）分、（1.00±0.63）分。术前平均ODI分别为29.64%±7.85%、32.17%±7.59%、28.20%±4.26%、20.67%±4.63%；末次随访时分别为5.09%±3.59%、4.78%±3.78%、4.80%±3.39%、4.00%±1.18%。术前平均腰骶角分别为20.61°±4.92°、23.78°±5.84°、25.10°±4.28°、21.67°±4.27°；术后分别为27.17°±3.66°、30.56°±5.31°、32.10°±4.01°、24.83°±2.32°；末次随访时分别为23.89°±3.12°、27.00°±5.46°、29.00°±4.85°、23.33°±2.50°。结论与前后联合入路手术相比，�Objective To study the efficacy and safety of four surgical techniques of tuberculosis of lumbosacral junction retrospectively. Methods Between Jul 2001 and Jan 2013, 79 patients with lumbosacral spinal tuberculosis underwent surgery. Antituberculous chemotherapy and nutrition support prior to surgery were used for at least two weeks. 45 patients underwent single stage radical debridement, fusion and anterior instrumentation （A group）. 18 patients underwent combined anterior and posterior spinal surgery （AP group）, 10 patients underwent transpedicular drainage, posterior instrumentation, and fusion （P group）, and 6 patients underwent anterior radical debridement （D group）. All the patients were treated by antituberculous chemotherapy for 18 months and followed regularly. The operation duration, blood loss, clinical status, ESR, VAS, ODI, roentgenogram and 3D-CT were concerned to estimate the progress of tuberculosis. Radiographs were analyzed before surgery, immediately after surgery, and at the final follow-up examination to assess the result of anterior fusion and maintenance of correction. Results There was no inju-ry of blood vessel, ureter or cauda equina during surgery. The mean follow-up period was 23 months （range 18-42 months）. No obvious loss of deformity correction was observed. There was no recurrence, no tuberculous peritonitis, and no incidence of im-potence or retrograde ejaculation in any of these patients. The average operating duration（min） were 144.31 ± 23.18, 444.72 ± 141.63, 351.50 ± 85.25, 90.00 ± 29.66, respectively; The average blood loss（ml）were 266.67 ± 104.45, 988.99 ± 488.26, 890.00 ± 306.23, 200.00±104.88, respectively; The average Pre-op VAS were 4.71±1.79, 5.22±1.48, 3.30±1.64, 2.50±1.52, respectively;The average last follow-up VAS were 0.89±0.68, 0.90±0.74, 1.00±0.63, respectively; The average Pre-op ODI（%）were 29.64± 7.85, 32.17±7.59, 28.20±4.26, 20.67±4.63, respectively; The average last follow-up ODI（%）were 5.09±3.59, 4.78�

关 键 词：腰椎 骶骨 结核 脊柱 治疗结果 随访研究 

分 类 号：R687.3[医药卫生—骨科学]