Li Weiwei, Liu Jun, Gong Liqun, Zhou Yongchun, Duan Dapeng
Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China.
Department of Sports Medicine Research Center of Sports Medicine Xiangya Hospital, Central South University, Hunnan, Changsha, 410008, China.
BMC Surg. 2017 Dec 4;17(1):124. doi: 10.1186/s12893-017-0310-2.
The choice of surgical methods for lumbosacral tuberculosis is controversial due to the complex anterior anatomy and peculiar biomechanics of the lumbosacral junction. The objective of this study was to explore the clinical effect of posterior intervertebral space debridement with annular bone graft fusion and fixation for the treatment of lumbosacral tuberculosis.
We retrospectively analysed data from 23 patients with lumbosacral tuberculosis who had undergone posterior intervertebral space debridement with annular bone fusion and fixation between January 2008 and September 2014. The mean age of the patients was 49.0 years (range, 27-71), and the mean duration of disease until treatment was 10.2 months (range, 6-20). The lumbosacral angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, American Spinal Injury Association (ASIA) grade and Social Functioning-36 (SF-36) score were determined to ascertain the clinical effects of the treatment.
All patients underwent follow-up observation. The mean follow-up time was 34.2 months (range, 18-45), the mean operation time was 167.0 min (range, 130-210) and the mean blood loss was 767.4 ml (range, 500-1150). The lumbosacral angle was 21.0° ± 2.1° before operation, rising to 28.8° ± 1.7° after operation (p < 0.05) and being maintained thereafter. The mean VAS score before operation was 8.1 ± 0.6, decreasing to 1.2 ± 0.5 (p < 0.05) at the final follow-up. The mean ESR and CRP values were 49.1 ± 5.6 mm and 64.9 ± 11.9 mg/L, respectively, before operation, decreasing to normal at the final follow-up. The preoperative ASIA grade was C in 6 patients, D in 12 and E in 5. At the final follow-up, all patients had an ASIA grade of E except for one patient with a grade of D. For all patients, the SF-36 score at the final follow-up was higher than the preoperative and postoperative scores.
Posterior intervertebral space debridement with annular bone graft fusion and fixation is an effective treatment for lumbosacral spine tuberculosis.
由于腰骶部复杂的前方解剖结构和特殊的生物力学特点，腰骶部结核手术方式的选择存在争议。本研究的目的是探讨后路椎间间隙清创、环形植骨融合及内固定治疗腰骶部结核的临床效果。
我们回顾性分析了2008年1月至2014年9月期间接受后路椎间间隙清创、环形植骨融合及内固定的23例腰骶部结核患者的数据。患者的平均年龄为49.0岁（范围27 - 71岁），治疗前疾病的平均病程为10.2个月（范围6 - 20个月）。测定腰骶角、视觉模拟评分（VAS）、红细胞沉降率（ESR）、C反应蛋白（CRP）水平、美国脊髓损伤协会（ASIA）分级及健康调查简表36（SF - 36）评分，以确定治疗的临床效果。
所有患者均接受随访观察。平均随访时间为34.2个月（范围18 - 45个月），平均手术时间为167.0分钟（范围130 - 210分钟），平均失血量为767.4毫升（范围500 - 1150毫升）。术前腰骶角为21.0°±2.1°，术后升至28.8°±1.7°（p < 0.05），此后保持稳定。术前平均VAS评分为8.1±0.6，末次随访时降至1.2±0.5（p < 0.05）。术前ESR和CRP的平均值分别为49.1±5.6毫米和64.9±11.9毫克/升，末次随访时降至正常。术前ASIA分级：6例为C级，12例为D级，5例为E级。末次随访时，除1例为D级外，所有患者的ASIA分级均为E级。对于所有患者，末次随访时的SF - 36评分高于术前和术后评分。
后路椎间间隙清创、环形植骨融合及内固定是治疗腰骶部脊柱结核的有效方法。
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