Feng Daxiong, Kang Jianping, Hou Zongliang
Department of Orthopedics, Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Apr;22(4):408-10.
To explore the advantage and indication of combined anterior and posterior surgeries for lumbarsacral junction tuberculosis.
Eleven cases of the lumbarsacral junction tuberculosis were treated with combined anterior (radical debridement and autograft) and posterior (instrumentation and fusion) surgeries in one stage between January 2002 and December 2006. There were 9 males and 2 females with the age of 20-56 years old. The course of disease was 4 to 15 months, 6 months on average. The lessons were located at L5, S1 in 7 patients, at L4,5, S1 in 2 patients and at L5, S2 in 2 patients. The involved vertebral bodies were at 2 segments in 7 patients; and 3 segments in 5 patients. The preoperative kyphosis was 5 to 8 degrees with an average 9 degrees. The sinus was associated in 3 patients, 3 patients had radiculopathy; 4 had paeumonophthisis and 9 had abscess.
The followed-up period was from 6 months to 3 years, 18 months on average. According to Chen score, among the 11 cases, there were excellent in 9, good in 2. All incisions were healed up primarily. After operation, spinal fusion was achieved in 10 cases within 5 months to 7 months, 6 months on average, and pseudoarthrosis in 1 case was found by the CT examination. The postoperative kyphosis was 0 to 4 degrees with the mean of 2 degrees and the radiculopathy in 3 cases all got nerve function recovery.
Lumbarsacral junction tuberculosis treated with this surgical technique can achieve a high satisfactory rate with restoring the spinal stability, arresting the disease early, providing early fusion, correcting the kyphosis and preventing progression of kyphosis particularly if lumbosacral spine tuberculosis is associated with sinus or preoperative diagnosis cannot exclude suppurative spondylitis.
探讨腰骶部结核前后路联合手术的优势及适应证。
2002年1月至2006年12月，对11例腰骶部结核患者行一期前后路联合手术（前路病灶清除植骨，后路内固定融合）。男9例，女2例，年龄20～56岁。病程4～15个月，平均6个月。病变部位：L5、S1 7例，L4、5、S1 2例，L5、S2 2例。累及椎体节段：2个节段7例，3个节段5例。术前后凸角5～8°，平均9°。3例有窦道形成，3例有神经根症状，4例有肺结核，9例有脓肿形成。
随访6个月至3年，平均18个月。按陈仲强评分标准，11例中优9例，良2例。所有切口均一期愈合。术后10例于5～7个月获得脊柱融合，平均6个月，CT检查发现1例假关节形成。术后后凸角0～4°，平均2°，3例神经根症状患者神经功能均恢复。
采用该手术技术治疗腰骶部结核，在恢复脊柱稳定性、早期控制病变、促进早期融合、矫正后凸畸形及防止后凸畸形进展方面可获得较高的满意率，尤其适用于合并窦道形成或术前诊断不能排除化脓性脊柱炎的腰骶部脊柱结核患者。
