Wang Q-Y, Huang M-G, Ou D-Q, Xu Y-C, Dong J-W, Yin H-D, Chen W, Rong L-M
Department of Spine Surgery, The third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, China.
J Musculoskelet Neuronal Interact. 2017 Mar 1;17(1):450-455.
We explored the efficacy of minimal invasive surgery including one-stage debridement and intervertebral fusion through extreme lateral channel (XLIF) combined with lateral or percutaneous posterior pedicle screw fixation for the treatment of lumbar spine tuberculosis.
Twenty two patients with lumbar tuberculosis who underwent surgery with XLIF technique and internal fixation were included in the study. Their data about operative time, intraoperative blood loss, bone fusion, kyphosis correction, and clinical recovery were retrospectively collected and analyzed.
The mean intraoperative blood loss was 249.8±27.8 ml and the operative time 347.5±20.7 min. At the final follow-up, 11 to 15 months postoperatively, ESR and CRP were normal and pain (VAS) and Oswestry disability index (ODI) were significantly reduced (23.0±-3.1 vs 0.6±-0.7 and 57.2±-1.6 vs 6.4±-1.2 respectively) compared to preoperative values. Progression of the kyphotic deformity was effectively prevented (mean Cobb angle 23.9° +/-1.9° vs 24.5° +/-1.4°, P>0.05). There was one failure of the fixation associated to poor therapy adherence. All the patients showed neurological recovery.
Debridement and interbody fusion by extreme lateral channel combined with lateral or percutaneous posterior pedicle screw fixation effectively retained the spine stability and provided clinical and neurologic recovery in selected patients with lumbar spine tuberculosis.
我们探讨了微创手术的疗效，该手术包括通过极外侧椎间孔入路（XLIF）进行一期清创和椎间融合，并结合外侧或经皮后路椎弓根螺钉内固定治疗腰椎结核。
本研究纳入了22例行XLIF技术及内固定手术的腰椎结核患者。回顾性收集并分析了他们的手术时间、术中出血量、骨融合情况、后凸畸形矫正情况及临床恢复情况等数据。
平均术中出血量为249.8±27.8毫升，手术时间为347.5±20.7分钟。在术后11至15个月的最终随访中，血沉（ESR）和C反应蛋白（CRP）恢复正常，与术前相比，疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）显著降低（分别为23.0±-3.1与0.6±-0.7以及57.2±-1.6与6.4±-1.2）。后凸畸形进展得到有效预防（平均Cobb角23.9°±1.9°与24.5°±1.4°，P>0.05）。有1例因治疗依从性差导致内固定失败。所有患者均显示神经功能恢复。
极外侧椎间孔入路进行清创和椎间融合并结合外侧或经皮后路椎弓根螺钉内固定，能有效保持脊柱稳定性，并使部分腰椎结核患者获得临床及神经功能恢复。
