Xiao Lianping, Jiang Yi, Tian Yonggang, Li Xiaodong, Yin Qingwei, Liu Zhi, Han Liqiang, Fu Jiaxin
Department of Orthopedics, Tianjin Third Central Hospital, Tianjin 300170, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Aug;23(8):913-6.
To evaluate the clinical outcomes of primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach in treating tuberculosis of the lumbosacral junction.
From February 2002 to April 2007, 16 patients with tuberculosis of the lumbosacral junction underwent anterior radical debridement, autologous iliac bone graft (two pieces of iliac bone, 5 cm x 3 cm in size), and internal fixation via transperitoneal approach, including 4 males and 12 females aged 27-63 years old (average 38 years old). The course of the disease ranged from 6 to 18 months (average 10 months). All patients experienced various degrees of pain in the lumbosacral area and toxic symptoms of the tuberculosis. Nine cases were complicated with radicular pain in the lower extremities, and 3 cases had saddle area anaesthesia. Two cases were initially diagnosed as lumbar intervertebral disc protrusion and treated accordingly. The segments involved by the tuberculosis were L5-S1 level in all cases. The average erythrocyte sedimentation rate (ESR) was 61 mm/hour. Imaging examination confirmed the diagnosis of spinal tuberculosis. All cases received four antitubercular drugs and nutrition support for nerve before operation. Operation was performed when hepatorenal function was normal, and the toxic symptom of the tuberculosis was under control or ESR was decreased.
Operation was performed safely in all cases without injuries of abdominal viscera, major blood vessel, cauda equina nerve and ureter. All wounds healed by first intention. No recurrence of tuberculosis and formation of sinuses occurred. All cases were followed up for 12-37 months (average 21 months). No such complications as tuberculous peritonitis and intestinal obstruction occurred. No postoperative erectile dysfunction and retrograde ejaculation occurred in the 4 male patients. ESR was recovered to normal 3-6 months after operation, and regular X-ray and CT exams showed no displacement of grafted bone. All patients achieved bony fusion 12 months after operation without the occurrence breakage and loosening of titanium plate and screw. The radical pain in the lower extremities and the saddle area anaesthesia disappeared. Four patients had pain in the iliac donor site, 2 patients had mild pain in the lumbosacral area, and the pain was eliminated after symptomatic treatment. The therapeutic effect was graded as excellent in 14 cases and good in 2 cases according to the therapeutic effect evaluation criteria of Chen and co-workers.
The surgical treatment of tuberculosis of the lumbosacral junction with primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach can achieve satisfying bony fusion and reconstruct spinal stability.
评估经腹膜入路一期前路病灶清除、自体骨移植及内固定治疗腰骶部结核的临床疗效。
2002年2月至2007年4月，16例腰骶部结核患者行经腹膜入路前路病灶清除、自体髂骨移植（两块髂骨，大小为5 cm×3 cm）及内固定术，其中男性4例，女性12例，年龄27 - 63岁（平均38岁）。病程6 - 18个月（平均10个月）。所有患者均有不同程度的腰骶部疼痛及结核中毒症状。9例合并下肢根性痛，3例有鞍区感觉障碍。2例最初诊断为腰椎间盘突出症并按此治疗。所有病例结核累及节段均为L5 - S1水平。平均红细胞沉降率（ESR）为61 mm/小时。影像学检查确诊为脊柱结核。所有病例术前均接受四种抗结核药物及神经营养支持治疗。在肝肾功能正常、结核中毒症状得到控制或ESR下降后行手术治疗。
所有病例手术均顺利进行，未损伤腹腔脏器、大血管、马尾神经及输尿管。所有伤口均一期愈合。无结核复发及窦道形成。所有病例随访12 - 37个月（平均21个月）。未发生结核性腹膜炎及肠梗阻等并发症。4例男性患者术后未出现勃起功能障碍及逆行射精。术后3 - 6个月ESR恢复正常，定期X线及CT检查显示植骨无移位。所有患者术后12个月均达到骨性融合，未发生钛板及螺钉断裂、松动。下肢根性痛及鞍区感觉障碍消失。4例患者供骨区髂部疼痛，2例患者腰骶部轻度疼痛，经对症治疗后疼痛消失。根据陈等人的疗效评价标准，疗效评定为优14例，良2例。
经腹膜入路一期前路病灶清除、自体骨移植及内固定治疗腰骶部结核可获得满意的骨性融合，重建脊柱稳定性。
