后路360°病灶清除联合双钛笼植骨融合治疗伴侧方移位的胸腰段结核1例报告及文献复习  

Posterior 360°debridement combined with double titanium mesh bone graft fusion in treatment of thoracolumbar tuberculosis with lateral displacement:A case report and literature review

作　　者：李新贺 陈冰[2] 朱庆三[1] 宋丽丽 武云涛[1] 栾双蔚 刘昊川[1] LI Xinhe;CHEN Bing;ZHU Qingsan;SONG Lili;WU Yuntao;LUAN Shuangwei;LIU Haochuan(Department of Orthopedics,China-Japan Union Hospital,Jilin University,Changchun 130033,China;Department of Anesthesiology,China-Japan Union Hospital,Jilin University,Changchun 130033,China;Department of Hand Surgery,China-Japan Union Hospital,Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院脊柱外科,吉林长春130033 [2]吉林大学中日联谊医院麻醉科,吉林长春130033 [3]吉林大学中日联谊医院手外科,吉林长春130033

出　　处：《吉林大学学报（医学版）》2021年第2期489-496,共8页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金项目(81671220);吉林省科技厅科技发展计划项目(20190905003SF)。

摘　　要：目的:探讨后路360°病灶清除联合双钛笼植骨融合治疗伴侧方移位的胸腰段结核的可行性。方法:收集1例伴有侧方移位的胸腰段结核患者的临床资料,分析患者手术治疗方法和临床疗效,并进行相关文献复习。结果:患者,女性,41岁,因腰背部疼痛半年、加重伴双下肢麻木无力半个月入院。查体见腰背部隆起,叩痛明显,双侧腹股沟水平下浅感觉减退。双下肢各肌群肌力Ⅱ级,双下肢肌张力正常。生理反射及病理反射均未引出。实验室检查,结核感染T细胞检测(T-SPOT)阳性;红细胞沉降率(ESR) 76 mmHg;C反应蛋白(CRP) 55.19 mg·L~(-1)。影像学检查,L1椎体病理性骨折,T12/L1椎体及椎间隙破坏,胸腰段后凸畸形伴侧方移位,双侧腰大肌、椎管及椎旁脓肿。诊断为胸腰段脊柱结核(T12、L1)、胸腰段侧后凸畸形、双下肢不全瘫、腰大肌及椎旁脓肿。术中充分清除椎间、椎旁病灶和重建脊柱的稳定性。患者手术顺利完成,症状明显缓解,胸腰段生理曲度恢复及植骨骨性融合良好。术后1年,Frankel分级由术前B级恢复至E级,视觉模拟疼痛评分(VAS)由术前7分降至1分,腰椎功能障碍指数(ODI)评分由术前78%降至术后16%,无复发,预后佳。结论:后路360°病灶清除联合双钛笼支撑合并结构植骨和颗粒植骨可为伴侧方移位的胸腰段结核提供良好的椎体间支撑及融合效果,同时也能充分地清除椎间及椎旁病灶,可作为治疗此类疾病的一种手术方式。Objective:To discuss the feasibility of treating thoracolumbar tuberculosis with lateral displacement using the combination of posterior 360°debridement and double titanium mesh bone graft fusion.Methods:The clinical data of a patient of thoracolumbar tuberculosis with lateral displacement were collected and the surgical treatments and clinical efficacy of the patient were analyzed and the relative literatures were reviewed.Results:The 41-year-old woman patient was admitted to the hospital due to backache for half a year and aggravation with numbness and weakness of both lower limbs for half a month.The physical examination showed a bulge on the lower back,obvious percussion pain and the hypoesthesia at the level of bilateral groin.The muscle strength of each muscle group of both lower limbs was gradeⅡand the muscle tension was normal.The physiological and pathological reflexes were not elicited.The laboratory examination results showed T cells spot test of tuberculosis infection(T-SPOT)(+),erythrocyte sedimentation rate(ESR)76 mmHg and C-reactive protein(CRP)55.19 mg·L-1.The imaging results indicated the pathological fracture of L1 vertebral body,damage of T12/L1 vertebral body and intervertebral space,thoracolumbar kyphosis with lateral displacement and abscess in bilateral psoas major,spinal canal and paravertebral parts.The diagnosis was thoracolumbar spinal tuberculosis(T12,L1),lateral kyphosis of thoracolumbar,incomplete paralysis of both lower limbs and abscess in psoas major and paravertebral parts.The intervertebral and paravertebral focus were fully removed and the spinal stability was reconstructed during the operation.The operation was successful,the patient’s symptoms were obviously relieved,the physiological curvature of the thoracolumbar was recovered,and the bone graft fusion was good.One year after the operation,the Frankel Classification returned to E from preoperative B,the visual analogue score(VAS)was decreased from 7 points before the operation to 1 point,and the oswestry disability in

关 键 词：胸腰段结核 侧方移位 360°病灶清除 双钛笼 植骨融合 

分 类 号：R639[医药卫生—外科学]