Wang Wen-Jun, Chen Wen-Kang, Yan Yi-Guo, Yao Nu-Zhao, Wang Cheng
Department of Spine Surgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan 421001, China.
Medicine (Baltimore). 2017 Jun;96(26):e7103. doi: 10.1097/MD.0000000000007103.
This study aimed to determine the efficacy and safety of anterior debridement and reconstruction with anatomical screw-plate fixation in patients with lumbosacral junction tuberculosis (TB).A total of 48 patients (30 males and 18 females) diagnosed with lumbosacral junction TB were included in this study. All patients underwent surgery in our institution from January 2008 to July 2014, using anterior debridement and reconstruction with anatomical screw-plate. Outcome data were evaluated before and after surgery and included lumbosacral angle, Frankel classification, bone fusion, and visual analog scale (VAS) scores.All patients were then followed up for an average of 49.4 months (range, 24-96 months). The mean lumbosacral angle improved from 8.36° ± 5.92° pre-operation to 22.38° ± 4.52° post-operation and 21.13° ± 3.73° during the final follow-up (both P < .05). Solid vertebral fusion was achieved in all patients after 7.6 months on average (range, 6-12 months). No severe complications appeared during operation and post-operation. Neurological performance and VAS scores were significantly improved compared with pre-operation (P < .05).Following standard anti-TB chemotherapy, anterior debridement and reconstruction with anatomical screw-plate fixation may be a feasible and effective therapeutical option for lumbosacral junction TB. This procedure can result in satisfactory bone fusion and deformity correction, and effectively restore lumbosacral junction stability.
本研究旨在确定腰骶部结核患者采用前路清创及解剖型螺钉钢板固定重建术的疗效和安全性。本研究共纳入48例诊断为腰骶部结核的患者(30例男性,18例女性)。所有患者于2008年1月至2014年7月在我院接受手术,采用前路清创及解剖型螺钉钢板固定重建术。对手术前后的结果数据进行评估,包括腰骶角、Frankel分级、骨融合情况及视觉模拟评分(VAS)。然后对所有患者进行平均49.4个月(范围24 - 96个月)的随访。腰骶角平均度数从术前的8.36°±5.92°改善至术后的22.38°±4.52°,末次随访时为21.13°±3.73°(均P < 0.05)。所有患者平均7.6个月(范围6 - 12个月)后均实现了椎体牢固融合。手术及术后均未出现严重并发症。与术前相比,神经功能及VAS评分均有显著改善(P < 0.05)。在标准抗结核化疗的基础上,前路清创及解剖型螺钉钢板固定重建术可能是治疗腰骶部结核的一种可行且有效的治疗选择。该手术可实现满意的骨融合及畸形矫正,并有效恢复腰骶部稳定性。