Lee J S, Moon K P, Kim S J, Suh K T
Pusan National University Hospital, Pusan, Korea.
J Bone Joint Surg Br. 2007 Feb;89(2):210-4. doi: 10.1302/0301-620X.89B2.17849.
There are few reports of the treatment of lumbar tuberculous spondylitis using the posterior approach. Between January 1999 and February 2004, 16 patients underwent posterior lumbar interbody fusion with autogenous iliac-bone grafting and pedicle screw instrumentation. Their mean age at surgery was 51 years (28 to 66). The mean follow-up period was 33 months (24 to 48). The clinical outcome was assessed using the Frankel neurological classification and the Kirkaldy-Willis criteria. On the Frankel classification, one patient improved by two grades (C to E), seven by one grade, and eight showed no change. The Kirkaldy-Willis functional outcome was classified as excellent in eight patients, good in five, fair in two and poor in one. Bony union was achieved within one year in 15 patients. The mean pre-operative lordotic angle was 27.8 degrees (9 degrees to 45 degrees ) which improved by the final follow-up to 35.8 degrees (28 degrees to 48 degrees ). Post-operative complications occurred in four patients, transient root injury in two, a superficial wound infection in one and a deep wound infection in one, in whom the implant was removed. Our results show that a posterior lumbar interbody fusion with autogenous iliac-bone grafting and pedicle screw instrumentation for tuberculous spondylitis through the posterior approach can give satisfactory results.
关于采用后路手术治疗腰椎结核性脊柱炎的报道较少。在1999年1月至2004年2月期间，16例患者接受了后路腰椎椎间融合术，并采用自体髂骨移植和椎弓根螺钉内固定。他们手术时的平均年龄为51岁（28至66岁）。平均随访期为33个月（24至48个月）。采用Frankel神经功能分级和Kirkaldy-Willis标准评估临床结果。根据Frankel分级，1例患者改善了两级（从C级到E级），7例改善了一级，8例无变化。Kirkaldy-Willis功能结果分级为：8例优秀，5例良好，2例尚可，1例差。15例患者在1年内实现了骨融合。术前平均前凸角为27.8度（9度至45度），至末次随访时改善至35.8度（28度至48度）。4例患者出现术后并发症，2例为短暂性神经根损伤，1例为浅表伤口感染，1例为深部伤口感染，后者移除了植入物。我们的结果表明，通过后路行后路腰椎椎间融合术并采用自体髂骨移植和椎弓根螺钉内固定治疗结核性脊柱炎可取得满意的效果。
