Li Wei-Wei, Liu Jun, Duan Liang, Duan Da-Peng, Wei Wen-Bo, Fan Ya-Yi
The First Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China;
The First Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China.
Zhongguo Gu Shang. 2017 Feb 25;30(2):137-141. doi: 10.3969/j.issn.1003-0034.2017.02.009.
To explore the clinical effects of posterior debridement, bone grafting via intervertebral space combined with internal fixation for the treatment of lumbosacral tuberculosis.
The clinical data of 32 patients with lumbosacral tuberculosis underwent the procedure of one-stage posterior intervertebral debridement, bone grafting and internal fixation from January 2007 to July 2013 were retrospectively analyzed. There were 17 males and 15 females, aged from 27 to 63 years with an average of (49.8±9.2) years. The course of disease was from 5 to 18 months with the mean of (10.7±3.2) months. There was involved the vertebral body of L₅ in 1 case, the intervertebral space of L₅S₁ in 8 cases, and the vertebral body of L₅ or S₁ combined with intervertebral space of L₅S₁ in 23 cases. VAS, ESR, CRP, the lumbosacral angle, the height of intervertebral space of L₅S₁, and ASIA grade were used to evaluate clinical effects.
All the patients were followed up from 18 to 39 months with an average of 21.6 months. Operative time was 120 to 260 min with the mean of 175 min, and intraoperative bleeding was 700 to 1 450 ml with the mean of 1 050 ml. VAS before operation was 8.4±1.6, then descended to 3.5±0.8(<0.05) on the 3rd month after operation and redescended to the level of 1.7±0.6(<0.05) at the final follow-up. The ESR and CRP before operation were (48.8±10.2) mm and (58.6±5.6) mg/L, respectively, then decreased to (35.6±6.9) mm and (22.5±4.3) mg/L (<0.05) at the 3rd month after operation and returned to the normal level at the final follow-up. The height of intervertebral space of L₅S₁ and lumbosacral angle before operation were (7.7±0.4) mm and (19.3±1.2)°, respectively, then improved to (10.3±0.3) mm and (22.4±1.5)° on the 3rd month after operation(<0.05), and maintained such level, no obvious lost at later. According to ASIA grade, 8 cases were grade C, 19 were grade D, 5 were grade E before operation, and at final follow-up, 1 case still was grade D, others were grade E.
The procedure of posterior debridement, bone grafting via intervertebral space combined with internal fixation is an effective and safe method in treating lumbosacral tuberculosis, it can effectively debride tuberculose focus, maintain the spinal stability, and improve the dysfunction with less complication.
探讨后路病灶清除、经椎间隙植骨联合内固定治疗腰骶部结核的临床效果。
回顾性分析2007年1月至2013年7月期间接受一期后路经椎间隙病灶清除、植骨及内固定手术的32例腰骶部结核患者的临床资料。其中男性17例，女性15例，年龄27～63岁，平均（49.8±9.2）岁。病程5～18个月，平均（10.7±3.2）个月。L₅椎体受累1例，L₅S₁椎间隙受累8例，L₅或S₁椎体合并L₅S₁椎间隙受累23例。采用视觉模拟评分法（VAS）、红细胞沉降率（ESR）、血清C反应蛋白（CRP）、腰骶角、L₅S₁椎间隙高度及美国脊髓损伤协会（ASIA）分级评估临床效果。
所有患者均获随访，随访时间18～39个月，平均21.6个月。手术时间120～260分钟，平均175分钟；术中出血量700～1450毫升，平均1050毫升。术前VAS评分为8.4±1.6，术后第3个月降至3.5±0.8（<0.05），末次随访时进一步降至1.7±0.6（<0.05）。术前ESR和CRP分别为（48.8±10.2）毫米和（58.6±5.6）毫克/升，术后第3个月分别降至（35.6±6.9）毫米和（22.5±4.3）毫克/升（<0.05），末次随访时恢复至正常水平。术前L₅S₁椎间隙高度和腰骶角分别为（7.7±0.4）毫米和（19.3±1.2）°，术后第3个月分别改善至（10.3±0.3）毫米和（22.4±1.5）°（<0.05），且维持该水平，后期无明显丢失。根据ASIA分级，术前8例为C级，19例为D级，5例为E级；末次随访时，1例仍为D级，其余为E级。
后路病灶清除、经椎间隙植骨联合内固定是治疗腰骶部结核的一种有效、安全的方法，能有效清除结核病灶，维持脊柱稳定性，改善功能障碍，且并发症较少。
