旁正中腹膜外入路治疗腰骶段脊柱结核  

Paramedian abdominal incision and retroperitoneal approach for surgical treatment of lumbosacral tuberculosis

作　　者：周忠杰[1] 宋跃明[1] 李涛[1] 刘立岷[1] 龚全[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国矫形外科杂志》2018年第2期122-126,共5页Orthopedic Journal of China

摘　　要：[目的]探讨旁正中腹膜外入路在腰骶段脊柱结核手术中的应用及其临床疗效。[方法]2010年1月~2014年12月,应用旁正中腹膜外入路治疗腰骶椎结核患者共40例。其中男22例,女18例。平均年龄32.61岁。平均病程6.12个月。所有主要受累节段均为L5~S1,1例伴有L2椎体的跳跃性的小范围结核病灶,但不合并明显脓肿,1例伴有T5~7椎结核;1例向上累及到L4;3例向下累及到S2椎体;1例累及到S3椎体前份,1例累及S4。合并神经损害5例,均为Frankel D级。22例在该入路下完成固定融合,16例由该入路完成病灶清除及植骨,一期或二期后路短节段固定融合术。记录手术时间、术中失血量、手术并发症等,评估神经功能恢复情况、疼痛视觉模拟评分、腰骶角、植骨融合和结核病灶愈合情况。[结果]手术时间平均(197.44±54.37)min,失血量平均(315.10±72.05)ml。无血管、神经损伤并发症。5例术前有神经功能损害者均恢复正常,评定为Frankel E级。1例男性患者出现逆行射精。随访时间18~28个月。术后1年所有患者均达到植骨融合,无结核复发、内固定松动和断裂或植骨块的移位。VAS评分由术前(6.20±1.17)分显著减少至术后(1.88±0.98)分,进一步减少至末次随访时(0.80±0.73)分,三个时间点间差异均有统计学意义(P<0.05)。腰骶角由术前(110.63±8.10)°增加至术后(124.39±5.43)°,差异具有统计学意义(P<0.05);但末次随访时回落至(119.42±5.12)°,后两时间点间差异无统计学意义(P>0.05)。[结论]旁正中腹膜外入路可有效清除腰骶椎结核病灶,具有创伤小、并发症少、容易操作等优势。[Objective] To explore clinical outcome of the surgical treatment of lumbosacral tuberculosis through a parame- dian abdominal incision and retroperitoneal approach （PAIRA）. [Methods] From Jan 2010 to Nov 2014, a total of 40 patients with lumbosacral tuberculosis were surgically treated through the paramedian abdominal incision and retroperitoneal approach, including 22 males and 18 females with an average age of 32.61 years with mean course of disease of 6.12 months. The primary lesion involved the L~ and S~ in all of the patients, additionally, accompanied with a skip lesion at L2 in 1 patient, a skip lesion from T5 to T7 in 1, L4 affected in 1, $2 affected in 3, $3 affected in 1 and $4 affected in 1 patient. Neurologic impairment was de- tected in 5 patients who all were graded as Frankel Grade D. Of them, 22 patients had the affected spine stabilized through the PAIRA following debridement at the same stage, while the remaining 19 patients received debridement through the PAIRA com- bined with staged pedicle screws fixation through an additional posterior approach. Operation time, blood loss, surgery complica- tions were recorded, in addition, neurological function,visual analogue score （VAS）, Dubousset＇s lumbosacral angle,bony fusion and tuberculosis healing were evaluated during follow-up. [Results] The operation lasted for （197.44±54.37） min with blood loss of （315.10±72.05） ml on average. No vascular or neurological damages occurred in any patient during surgery, however, ret- rograde ejaculation was reported in one patient of this group. All the patients were followed up from 18 to 28 months. The VAS significantly decreased from （6.20± 1.17） before operation to （1.88±0.98） postoperatively, further to （0.80±0.73） at the latest fol- low up, with statistical differences among time points （P〈0.05）. All the 5 patients with neurologic impairment before surgery gotcomplete recovery at the latest follow up, graded as Frankel Grade E. In addition, Dubousset＇s lumbosacral

关 键 词：腰骶椎结核 旁正中腹膜外入路 手术治疗 

分 类 号：R529.2[医药卫生—内科学]