腰骶椎结核单纯后路手术联合局部置管早期持续化疗的临床疗效  

Clinical effect of simple posterior surgery combined with early continous intralesional chemotherapy through local catheterization for lumbosacral tuberculosis

作　　者：黄云飞 杨小彬[1] 李田 章雪芳 赵志刚[1] 昌震[1] 郝定均[1] 贺宝荣[1] 都金鹏 HUANG Yunfei;YANG Xiaobin;LI Tian;ZHANG Xuefang;ZHAO Zhigang;CHANG Zhen;HAO Dingjun;HE Baorong;DU Jinpeng(Department of Spinal Surgery,Honghui Hospital Affiliated to Xi'an Jiaotong University,Xi'an,Shaanxi 710054,China;不详)

机构地区：[1]西安交通大学附属红会医院脊柱外科,710054 [2]西北大学附属中学浐灞中学,西安710068

出　　处：《中国骨科临床与基础研究杂志》2024年第3期165-171,共7页Chinese Journal of Orthopaedic Clinical and Basic Research

摘　　要：目的 探讨单纯后路病灶清除植骨融合内固定联合局部置管早期持续病灶内化疗治疗腰骶椎结核的临床疗效。方法 回顾性分析2014年1月至2018年1月西安交通大学附属红会医院收治的32例腰骶椎结核患者的临床资料,患者均采用单纯后路病灶清除植骨融合内固定联合局部置管早期持续化疗(即术中局部置管、术后1个月内经导管向病灶内持续注入异烟肼)。所有患者腰、骶椎结核均以单节段椎体及椎间隙破坏为主;22例存在椎旁或椎管内少量脓肿,但脓肿范围局限在病变节段范围内,未发生远处流注及两侧腰大肌侵袭。记录手术时间、术中出血量、卧床时间、围手术期并发症、导管注入抗结核药物情况及药物不良反应,评估手术前后疼痛视觉模拟量表(VAS)评分和美国脊柱损伤协会(ASIA)分级,通过腰椎正侧位X线片或三维CT评估植骨融合情况,监测红细胞沉降率(ESR)、C-反应蛋白(CRP)变化。结果 手术时间(116.2±15.4)min,术中出血量(320.2±103.4)m L,卧床时间(4.7±1.2)d;无大血管或神经损伤、硬脊膜破裂病例,伤口均一期愈合,无深部感染发生。随访时间12~24个月(平均15个月)。患者术后4~10个月均获骨性融合;术后3个月ESR、CRP均恢复正常,末次随访VAS评分和后凸Cobb角较术前明显改善(P <0.05)。22例术前存在神经损伤的患者末次随访时均有不同程度恢复;末次随访未见结核复发,随访期间无结核药物严重不良反应发生。结论 对以椎体及椎间隙破坏为主、椎旁或椎管内脓肿范围局限、伴节段不稳及神经损伤的单节段腰骶椎结核,予以单纯后路手术联合局部置管早期持续病灶内化疗可获得满意疗效。Objective To explore the clinical efficacy of posterior debridement,bone graft fusion and internal fixation combined with early continuous intralesional chemotherapy through local catheterization in the treatment of lumbosacral tuberculosis.Methods Clinical data of 32 patients with lumbsacral tuberculosis admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2014 to January 2018 were retrospectively analyzed.All patients were treated with simple posterior lesion removal,bone grafting fusion and internal fixation combined with early continuous chemotherapy with local catheterization(that is,intraoperative local catheterization,and postoperative continuous injection of isoniazid into the lesion via catheter for 1 month).Lumbosacral tuberculosis of all patients was mainly characterized by destruction of vertebral body and intervertebral space.A small amount of paravertebral or intraspinal abscess was present in 22 cases.The abscess was confined to the involved segment without distant injection or invasion to bilateral psoas major muscles.Operative time,intraoperative blood loss,bed time,perioperative complications,catheterization of anti-tuberculosis drugs and drug side effects were recorded.Visual analogue scale(VAS) scores and American Spinal Injury Association(ASIA) grading were evaluated before and after surgery.Graft fusion was observed by lumbar anteroposterior and lateral X-ray or 3D CT,and changes of erythrocyte sedimentation rate(ESR) and C-reaction protein(CRP) were also monitored.Results Operative time was(116.2 ± 15.4) min,intraoperative blood loss was(320.2 ± 103.4) m L,and the time in bed was(4.7 ± 1.2) d.There were no major vascular or nerve injury or dural rupture cases,all wounds healed in one stage,and no deep infection occurred.Patients were followed up for 12 to 24 months(average,15 months).Bone fusion was achieved in all patients at 4 to 10months after operation.ESR and CRP in all patients returned to normal at 3 months after operation.VAS score and kyphotic Cobb a

关 键 词：结核 脊柱 腰椎 骶骨 清创术 脊柱融合术 骨移植 化学疗法 辅助 导管 留置 

分 类 号：R529.23[医药卫生—内科学] R687.3[医药卫生—临床医学] R453