Liu Jia-Ming, Zhou Yang, Peng Ai-Fen, Chen Xuan-Yin, Chen Wen-Zhao, Long Xin-Hua, Huang Shan-Hu, Liu Zhi-Li
Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China.
School of Humanities, Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, PR China.
Clin Neurol Neurosurg. 2017 Feb;153:67-72. doi: 10.1016/j.clineuro.2016.12.013. Epub 2016 Dec 28.
Lumbosacral spinal tuberculosis is rare in current population. Previous studies have reported effective outcomes about anterior, antero-posterior and posterior surgery for treating tuberculosis of lumbosacral region. However, the bone grafts used in these studies are mainly structural bone and mesh cage. The purpose of this study is to evaluate the efficacy and safety of nonstructural autograft in the surgical treatment of lumbosacral tuberculosis by one-stage posterior procedure.
A total of 21 patients with lumbosacral tuberculosis were retrospectively reviewed between January 2012 and December 2014. All the patients underwent one-stage posterior debridement, interbody fusion with nonstructural autograft and posterior instrumentation. The preoperative and postoperative erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) and visual analogue scale (VAS) were recorded. Preoperative and postoperative lumbosacral angle and intervertebral space height were measured on the plain films. American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate the neurological outcomes of the patients.
The average follow up period was 22.9±6.7months (range 12-36 months). The preoperative ESR and CRP were 33.4±10.5mm/h and 30.3±20.3mg/l, respectively, which decreased to 15.2±7.1mm/h and 10.6±5.8mg/l postoperatively with significant differences (P<0.05). The lumbosacral angles and intervertebral space height were increased from preoperative 20.4°±4.5° and 9.7±1.9mm to postoperative 25.6°±4.6° and 12.3±2.1mm, respectively (P<0.001 and P<0.001). At the final follow up, a loss of 2.1°of lumbosacral angles and 1.6mm of intervertebral space height was observed. The VAS scores were decreased from 4.73 to 2.71. Bony fusion was achieved in all patients at 6 months after surgery. Neurological outcomes were improved with 1-2 grades in most of the patients. One patient got wound infection and was cured by daily dressing. Complications related to instrumentation or neurological deficit weren't observed.
Combined with one-stage posterior debridement and instrumentation, interbody fusion with nonstructural autograft is an effective option for lumbosacral tuberculosis.
腰骶部脊柱结核在当前人群中较为罕见。既往研究报道了前路、前后路及后路手术治疗腰骶部结核的有效结果。然而，这些研究中使用的骨移植材料主要是结构性骨和网笼。本研究的目的是评估一期后路手术中使用非结构性自体骨移植治疗腰骶部结核的疗效和安全性。
回顾性分析2012年1月至2014年12月期间共21例腰骶部结核患者。所有患者均接受一期后路清创、非结构性自体骨移植椎间融合及后路内固定术。记录术前及术后红细胞沉降率（ESR）、C反应蛋白（CRP）和视觉模拟评分（VAS）。在X线平片上测量术前及术后腰骶角和椎间隙高度。采用美国脊髓损伤协会（ASIA）损伤分级评估患者的神经功能结果。
平均随访时间为22.9±6.7个月（范围12 - 36个月）。术前ESR和CRP分别为33.4±10.5mm/h和30.3±20.3mg/L，术后分别降至15.2±7.1mm/h和10.6±5.8mg/L，差异有统计学意义（P<0.05）。腰骶角和椎间隙高度分别从术前的20.4°±4.5°和9.7±1.9mm增加至术后的25.6°±4.6°和12.3±2.1mm（P<0.001和P<0.001）。末次随访时，观察到腰骶角丢失2.1°，椎间隙高度丢失1.6mm。VAS评分从4.73降至2.71。所有患者术后6个月均实现了骨融合。大多数患者神经功能改善1 - 2级。1例患者发生伤口感染，经每日换药治愈。未观察到与内固定或神经功能缺损相关的并发症。
一期后路清创、内固定联合非结构性自体骨移植椎间融合是治疗腰骶部结核的有效选择。
