单椎板切除病灶清除固定融合治疗腰骶段结核  

One-stage debridement through unilateral laminectomy combined instrumented fusion for lumbosacral tuberculosis

作　　者：蔡芝军 汤逊[1] 张建平[1] 李阳[1] 陈延岭 王静[1] 徐永清[1] CAI Zhi-jun;TANG Xun;ZHANG Jian-ping;LI Yang;CHEN Yan-ling;WANG Jing;XU Yong-qing(Department of Orthopaedic Surgery,920th Hospital of PLA Logistics Support Force,Kunming 650032,China)

机构地区：[1]中国人民解放军联勤保障部队第920医院骨科,昆明650032

出　　处：《中国矫形外科杂志》2020年第7期580-585,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81171734);云南省创新团队基金项目(编号:2009CI008);国家临床重点专科建设项目。

摘　　要：[目的]探讨一期经后路单侧椎板切除病灶清除、潜行扩大椎管减压、椎间植骨、椎弓根内固定治疗腰慨段结核的临床疗效。[方法]2008年1月~2014年1月,采用一期后路单侧椎板部分切除潜行扩大椎管减压术治疗35例腰骶段结核患者。男22例,女13例,年龄23~68岁,平均(50.54±12.65)岁。病程2个月~10年,平均(20.80±18.46)个月。[结果]所有患者顺利手术,术中无严重并发症。手术时间(203.29±41.74)min,出血(686.00±225.21)ml。33例切口I期愈合,2例切口感染,给予充分引流、冲洗换药、二次清创缝合,最终愈合。35例患者均获得随访,随访时间18~72个月,平均(30.11±14.69)个月。35例患者腰痛和下肢神经症状逐渐减轻,结核中毒症状较术前明显缓解,无结核复发。ASIA神经损害分级由术前C级5例、D级12例、E级18例,改善为末次随访时D级2例,E级33例(P<0.05)。末次随访时,VAS评分为(0.20±0.47),ODI评分(3.77±3.66),ESR(7.83±1.52)mm/h,CRP(2.43±0.98)mg/1,腰骶角(26.86±2.00)°,均较术前显著改善(P<0.05)。根据Bridwell分级标准,33例I级骨性愈合,2例Ⅱ级骨性愈合。[结论]一期经后路单侧椎板切除病灶清除、椎管减压、固定融合术可以有效清除病灶、保留更多腰椎后柱结构、重建腰椎曲度并维持腰骶段的稳定性,是腰骶段结核可选择的治疗方案。[Objective]To investigate the clinical efficacy of one-stage debridement through unilateral laminectomy,combined with latent expanded spinal canal decompression,interbody bone grafting and pedicle screw fixation for lumbosacral tuberculosis.[Methods]A retrospective study was conducted on 35 patients who underwent one-stage debridement through unilateral laminectomy combined with latent expanded spinal canal decompression and instrumented fusion for lumbosacral tuberculosis from January 2008 to January2014,including 22 males and 13 females,aged from 23 to 68 years with an average age of(50.54±12.65)years.The course of disease ranged from 2 months to 10 years with an average of(20.80±18.46)months.[Results]All the patients had surgical procedures performed smoothly with operation time of(203.29±41.74)min and intraoperative blood loss of(686.00±225.21)ml on average,whereas without serious complications,such as iatrogenic injuries to nerves,blood vessels and internal organs.Of them,33 patients got primary healing of the incisions,while the remaining 2 patients suffered from infection,which subsided by full drainage,dress changing and even secondary debridement.During the follow up period ranged from 18 to 72 months with a mean of(30.11±14.69)months,all the 35 patients achieved considerable improvements progressively regarding to low back pain,neurological symptoms and toxic symptoms of tuberculosis without recurrence of tuberculosis.The ASIA grades for neurologic function significantly changed for the better from Grade C in 5,Grade D in 12 and Grade E in 18 preoperatively to Grade D in 2 and Grade E in 33 at the latest follow up(P<0.05).At the last follow-up the VAS score of(0.20±0.47),ODI score of(3.77±3.66),ESR of(7.83±1.52)mm/h,GRP of(2.43±0.98)mg/1 and lumbosacral angle of(26.86±2.00)0 significantly improved compared with those before operation(P<0.05).Based on Bridwell’s criteria,the interbody fusion was marked as Grade I in 33 patients and Grade II in 2 patients.[Conclusion]This one-stage debridement

关 键 词：腰骶段结核 一期后路手术 单侧椎板切除 病灶清除 固定融合 

分 类 号：R529.2[医药卫生—内科学]