Lan Xu, Xu Jianzhong, Liu Xuemei, Ge Baofeng
Department of Spine Surgery, Lanzhou General Hospital, Lanzhou Command of Chinese PLA, Lanzhou Gansu 730050, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Oct;25(10):1176-9.
To investigate the effectiveness of radical debridement, reconstruction with bone allograft, and pedicle screw-rod internal fixation via combined anterior and posterior approach in the treatment of lumbosacral tuberculosis.
Between January 2005 and May 2010, 16 patients with lumbosacral tuberculosis were treated. Radical debridement was performed via extraperitoneal approach, then tricortical iliac bone allograft was placed and pedicle screw-rod internal fixation was used to reconstruct the spinal column. There were 12 males and 4 females aged 38-65 years (mean, 48 years). The disease duration ranged from 6 to 24 months (mean, 10 months). The main clinical symptom was persistent pain in lumbosacral area. The involved segments included L4,5 (3 cases), L5, S1 (8 cases), and l-S1 (5 cases). The lumbosacral angle was 18-32 degrees (mean, 22 degrees). The erythrocyte sedimentation rate (ESR) was 15-55 mm/1 hour (mean, 25 mm/1 hour). All the patients were given antituberculosis chemotherapy for 12 months after operation.
The operation time was 120-240 minutes (mean, 180 minutes). The amount of bleeding was 300-600 mL (mean, 420 mL). All wounds healed by first intention, and no relative complication occurred. All 16 cases were followed up 12-24 months (mean, 16 months). No recurrence occurred and ESR recovered to normal. Persistent pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray films demonstrated that bony fusion was obtained in all patients at 8-12 months postoperatively. The lumbosacral angle was 16-31 degrees (mean, 21 degrees) at last follow-up.
The extraperitoneal approach can provide direct and safe access to the lesion. The structural iliac bone allograft and posterior instrumentation could reconstruct effectively the stability of the lumbosacral junction.
探讨经前后联合入路病灶清除、同种异体骨移植重建及椎弓根螺钉-棒内固定治疗腰骶部结核的疗效。
2005年1月至2010年5月，治疗16例腰骶部结核患者。经腹膜外入路行病灶清除，然后植入三面皮质髂骨同种异体骨，并用椎弓根螺钉-棒内固定重建脊柱。患者中男性12例，女性4例，年龄38 - 65岁（平均48岁）。病程6至24个月（平均10个月）。主要临床症状为腰骶部持续性疼痛。受累节段包括L4、5（3例），L5、S1（8例），L5 - S1（5例）。腰骶角为18 - 32度（平均22度）。红细胞沉降率（ESR）为15 - 55mm/1小时（平均25mm/1小时）。所有患者术后均接受12个月抗结核化疗。
手术时间为120 - 240分钟（平均180分钟）。出血量为300 - 600mL（平均420mL）。所有伤口均一期愈合，未发生相关并发症。16例患者均随访12 - 24个月（平均16个月）。无复发，ESR恢复正常。腰骶部持续性疼痛及下肢根性疼痛消失。X线片显示所有患者术后8 - 12个月获得骨性融合。末次随访时腰骶角为16 - 31度（平均21度）。
腹膜外入路可提供直接、安全的病灶暴露途径。结构性髂骨同种异体骨移植及后路内固定可有效重建腰骶关节稳定性。
