Zhang Tao, Ma Lihua, Lan Xu, Zhen Ping, Wang Shiyong, Li Zhilin
Department of Spine Surgery, Lanzhou General Hospital, Lanzhou Command of Chinese PLA, Lanzhou, China.
Endocrinology Department, The First Hospital of Lanzhou University, Lanzhou, China.
Asian Spine J. 2017 Apr;11(2):305-313. doi: 10.4184/asj.2017.11.2.305. Epub 2017 Apr 12.
Retrospective case series.
To investigate the clinical efficacy and feasibility of one-stage anterolateral debridement, bone grafting, and internal fixation for treating lumbosacral tuberculosis.
There has been no consensus regarding the optimal means of treating lumbosacral tuberculosis. The one-stage anterolateral extraperitoneal approach for radical debridement, bone grafting, and internal fixation for treating lumbosacral tuberculosis is rare in literature.
Twenty-one patients with lumbosacral tuberculosis were retrospectively analyzed. All patients underwent the surgery of anterolateral debridement after regularly antituberculous drugs therapy. We evaluated the erythrocyte sedimentation rate, C-reactive protein, radiography, computed tomography, magnetic resonance imaging, visual analogue score, and Oswestry disability index before and after surgery.
All patients completed a follow-up survey 9-48 months after surgery. All patients' wounds healed well without chronic infection or sinus formation, and all patients with low-back pain reported relief after surgery. All cases had no tuberculosis recurrence. Solid bony fusion was achieved within 6-12 months. At final follow-up, evaluated the erythrocyte sedimentation rate decreased from 38.1±12.5 to 11.3±7.1 mm/hr, C-reactive protein decreased from 6.2±4.2 to 1.6±1.3 mg/dL, the visual analog scale score decreased from 4.6±1.1 to 1.4±1.0, the Oswestry disability index score decreased from 50.2%±11.9% to 13.0%±6.6%, and the lumbosacral angle increased from 20.0°±4.8° to 29.0°±3.9° (<0.05).
One-stage anterolateral debridement, bone grafting, and internal instrument fixation for treating lumbosacral tuberculosis is safe and effective.
回顾性病例系列研究。
探讨一期前路清创、植骨及内固定治疗腰骶部结核的临床疗效及可行性。
对于腰骶部结核的最佳治疗方法尚无共识。一期前路经腹膜外入路进行根治性清创、植骨及内固定治疗腰骶部结核在文献中较为少见。
对21例腰骶部结核患者进行回顾性分析。所有患者在规律抗结核药物治疗后均接受了前路清创手术。我们评估了手术前后的红细胞沉降率、C反应蛋白、X线摄影、计算机断层扫描、磁共振成像、视觉模拟评分和奥斯维斯特功能障碍指数。
所有患者在术后9至48个月完成了随访调查。所有患者伤口愈合良好，无慢性感染或窦道形成，所有腰痛患者术后疼痛均缓解。所有病例均无结核复发。6至12个月内实现了牢固的骨融合。在末次随访时，评估红细胞沉降率从38.1±12.5降至11.3±7.1mm/h，C反应蛋白从6.2±4.2降至1.6±1.3mg/dL，视觉模拟量表评分从4.6±1.1降至1.4±1.0，奥斯维斯特功能障碍指数评分从50.2%±11.9%降至13.0%±6.6%，腰骶角从20.0°±4.8°增加至29.0°±3.9°（P<0.05）。
一期前路清创、植骨及内固定器械治疗腰骶部结核安全有效。
