Lan Jiaping, Tang Xun, Xu Yongqing, Wang Shuhong, Zhang Zhi, Zheng Jiazhuang, Wang Fandong, Chen Yu, Cai Qilin, Ran Maobo, Liu Yuanbin
Department of Orthopaedics, Suining Central Hospital, Suining Sichuan, 629000, P. R. China.
Affiliated Orthopaedics Hospital, Trauma Orthopaedics Institute of Chinese PLA, Kunming General Hospital of Chengdu Military Command of Chinese PLA.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 May 8;30(5):585-589. doi: 10.7507/1002-1892.20160118.
To explore the effectiveness of stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation for the treatment of lumbosacral tuberculosis.
Seven cases of lumbosacral tuberculosis were treated by stage I anterior approach debridement, autologous iliac crest graft, and single self-locked titanium plate internal fixation between February 2010 and October 2014. There were 5 males and 2 females, aged 18-65 years (mean, 41.6 years). The disease duration was 5-21 months (mean, 8 months). The patients had signs and symptoms of pain in lumbosacral region, radiating pain in unilateral lower limb or bilateral lower limbs, decreased muscular strength and disorders of superficial sensation. According to Frankel classification for spinal injury, 1 case was rated as grade C, 3 cases as grade D, and 3 cases as grade E. Preoperative imaging examination suggested L, S lesions in line with the manifestations of tuberculosis; the lumbosacral angle was 16.4-28.5° (mean, 18.6°). The erythrocyte sedimentation rate was 28-105 mm/1 hour (mean, 61 mm/1 hour). All patients received 4-drug antituberculosis therapy.
All patients underwent the operation successfully and all incisions healed at stage I, without relevant complication. All patients were followed up 14-70 months (mean, 25.6 months). All symptoms of tuberculosis disappeared and the erythrocyte sedimentation rate returned to normal. At last follow-up, Frankel classification was returned to E from D in 3 cases, returned to D from C in 1 case. Two cases suffered from pains in the lumbosacral region and at the donor site, 1 case suffered from upper abdominal discomfort and poor appetite,but these symptoms disappeared after symptomatic treatment. At last follow-up, X-ray examination indicated that the lumbosacral angle was 23.4-34.2° (mean, 28.6°). According to Bridwell criteria, 5 cases gained grade I bone fusion, and 2 cases gained grade II bone fusion, without migration of bone graft, or loosening or breakage of titanium plate or bolt.
Stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation is safe and effective in treating lumbosacral tuberculosis. It can achieve good bone fusion and stable lumbosacral stability, and maintain good deformity correction.
探讨一期前路清创、自体髂骨植骨并单枚自锁钛板内固定治疗腰骶部结核的疗效。
2010年2月至2014年10月，采用一期前路清创、自体髂骨植骨并单枚自锁钛板内固定治疗7例腰骶部结核患者。其中男性5例，女性2例，年龄18 - 65岁（平均41.6岁）。病程5 - 21个月（平均8个月）。患者均有腰骶部疼痛、单侧或双侧下肢放射性疼痛、肌力下降及浅感觉障碍等症状和体征。按Frankel脊髓损伤分级，C级1例，D级3例，E级3例。术前影像学检查提示L、S病变符合结核表现；腰骶角为16.4 - 28.5°（平均18.6°）。血沉为28 - 105 mm/1小时（平均61 mm/1小时）。所有患者均接受四联抗结核治疗。
所有患者手术均成功，切口均一期愈合，无相关并发症。所有患者随访14 - 70个月（平均25.6个月）。结核症状均消失，血沉恢复正常。末次随访时，3例Frankel分级由D级恢复至E级，1例由C级恢复至D级。2例患者腰骶部及供骨区疼痛，1例患者上腹部不适、食欲欠佳，经对症治疗后症状消失。末次随访时，X线检查示腰骶角为23.4 - 34.2°（平均28.6°）。按Bridwell标准，5例获得Ⅰ级骨融合，2例获得Ⅱ级骨融合，无植骨块移位，钛板或螺钉无松动或断裂。
一期前路清创、自体髂骨植骨并单枚自锁钛板内固定治疗腰骶部结核安全有效。可获得良好的骨融合，维持腰骶部稳定，保持良好的畸形矫正效果。
