一期后路病灶清除结构性植骨治疗腰骶段脊柱结核研究  

One-stage posterior debridement, structural bone graft and instrumentation for lumbosacral tuberculosis

作　　者：李飞虎 谢恩[2] 郝定均[2] 吴起宁[2] 樊勇[2] 张振兴[2] 刘世长[2] 徐斌斌[2] 

机构地区：[1]陕西中医大学,712046 [2]西安交通大学医学部附属红会医院脊柱外科腰椎病区,710054

出　　处：《美中国际创伤杂志》2017年第1期30-34,共5页U.S.Chinese International Journal of Traumatology

摘　　要：目的：探讨一期后路病灶清除结构性植骨治疗腰骶段脊柱结核的临床疗效。方法：回顾性分析白2012年9月至2015年11月采用一期后路手术方式治疗并获得较满意疗效的腰骶段脊柱结核患者117例，其中男50例，女67例，平均年龄37.3岁（22～51岁）。术前所有患者均行X线片，CT及磁共振（MRI）检查，确定所有患者均为L4～S2范围内的腰骶段脊柱结核，所选取的117例患者均有不同程度的神经功能障碍（Frankel分级分别为：B级3例，C级60例，D级54例）。手术方式为一期后路病灶清除结构性植骨，并联合局部化疗方法，术前术后联合正规抗结核治疗。定期随访每间隔3个月一次，检查术后红细胞沉降率（ESR），摄X线片评估结核活动情况及植骨融合情况，对比记录术前后手术患者的腰骶角变化。并在每次随访时对患者VAS评分以及Frankel分级进行重新评估。结果：所有患者术后均获随访，平均（12．6±3．4）个月（10～21个月）。术中术后无严重并发症发生，随访期间未发生术后结核复发病例，患者腰骶部生理前凸曲度恢复均较为明显，从术前平均（13．3±5．4）。至术后平均（25．4±5．2）。（P〈0．05）；ESR于术后3月基本恢复正常，VAS评分在术后3月随访时均值（1．92±0．86）分（0．5-2）（P〈0．05）；术后椎间隙骨性融合平均需要8．9个月（8～12个月），无内固定松动及断裂。末次随访时117列患者均有不同程度的神经功能恢复，Frankel分级再次评分结果为：13例C级，36例D级，68例E级。结论：对于腰骶部脊柱结核，在术前术后的积极抗结核治疗的辅助下，通过行一期后路病灶清除结构性植骨是行之有效的治疗方案。Objective： To investigate the clinical effect of one-stage posterior debridement, structural bone graft and instrumentation for treatment of lumbosaeral tuberculosis. Methods： A total of 117 patients with lumbosaeral tuberculosis were reviewed retrospectively between September 2012 and November 2015, including 50 male and 67 female with an average age of 37.3 years old （range 22-51 years）. X-ray, CT and MRI examination were taken in all patients and determined the lesion segments were L4-S2. All patients had neurological dysfunction in different degrees （Frankel grade B, C and D in 3, 60 and 54 cases respectively）. All patients underwent one-stage posterior debridement, structural bone grafts and instrumentation, combined with local chemotherapy, pre- and post-operative regular antituberculosis treatment. Regular follow-up was carried out every 3 months, ESR and X-ray test were performed to evaluate the condition of tuberculosis activity and bone fusion. Meanwhile, VAS score and Frankel grade were reappraised at each follow-up visit. Results： All patients were followed-up for （12.6±3.4） months （range 10-21 month）, without any severe complications happed intra- and post-operatively, and also no tuberculosis recurrence found during follow-up period. Lumbosacral lordosis obviously improved from average （13.3±5.4）° to （25.4±5.2）° （P〈0.05）. 3 months after operation, ESR reached to normal value in principle, VAS score was mean （1.92±0.86） points （range 0.5-2） （P〈0.05）. Intervertebral space bony fusion need about 8.9 months, no internal fixation loosening and breakage noted. At the last follow-up visit, nerve function of all patients had recovered in different degrees, Frankel grade C in 13 cases, grade D in 36 cases and grade E in 68 cases. Conclusion： Assist with positive pre-and post-operative antituberculosis treatment, one-stage posterior debridement, structuralbone graft and instrumentation for lumbosacral tuberculosis is an effective treatment method.

关 键 词：腰骶椎 脊柱结核 后路病灶清除 

分 类 号：R529.2[医药卫生—内科学]