Chen Shujin, Ma Xiangyang, Yang Jincheng, Yang Min, Zou Xiaobao
Department of Spinal Surgery, General Hospital of Guangzhou Military Command of PLA, Guangzhou Guangdong, 510010, P.R.China;Graduate School, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China.
Department of Spinal Surgery, General Hospital of Guangzhou Military Command of PLA, Guangzhou Guangdong, 510010,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Apr 15;31(4):455-460. doi: 10.7507/1002-1892.201612079.
To investigate the effectiveness of extreme lateral channel debridement and fusion combined with posterior fixation for lumbar spinal tuberculosis.
A retrospective analysis was made on the clinical data of 17 patients with lumbar spinal tuberculosis undergoing extreme lateral channel debridement and fusion combined with posterior fixation between December 2008 and December 2014. There were 10 males and 7 females, aged 20-69 years (mean, 42.6 years). The disease duration was 1-6 months (mean, 3.4 months). The involved segments included L in 5 patients, L in 6 patients, L in 3 patients, and L in 3 patients. Based on American Spinal Injury Association (ASIA) classification, there were 2 cases of grade C, 13 cases of grade D, and 2 cases of grade E. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Barthel index were used to evaluate the effectiveness, and the improvement rate of JOA score and Barthel index was calculated at the same time. Lumbar X-ray film and CT were taken regularly to evaluate lumbar kyphotic Cobb angle correction and bony fusion.
The operation was successfully performed in 17 patients, and pathological examination showed tuberculosis. All cases were followed up 24-48 months (mean, 35.3 months). Lumbar X-ray film and CT showed that necrotic bone and abscess were cleared completely, and lumbar kyphosis correction was satisfactorily in all cases. Bony fusion was achieved within 6 months, and clinical cure was obtained within 18 months in all cases; no recurrence was found during follow-up period. No loosening or breakage of internal fixation was observed. At last follow-up, ASIA classification was recovered to grade D and grade E from grade C in 2 cases, to grade E from grade D in 11 cases and had no change in 2 cases (grade D). Two cases of ASIA grade E showed no neurological deficit. The VAS score, JOA score, Barthel index, and lumbar kyphotic Cobb angle were significantly improved at 2 weeks after operation and at last follow-up when compared with preoperative ones ( <0.05). At last follow-up, the improvement rate of JOA score was 75.2%±6.2% and the improvement rate of Barthel index was 75.7%±10.8%.
To use extreme lateral channel debridement and fusion combined with posterior fixation is an effective treatment for lumbar spinal tuberculosis.
探讨极外侧入路病灶清除融合联合后路内固定治疗腰椎结核的疗效。
回顾性分析2008年12月至2014年12月采用极外侧入路病灶清除融合联合后路内固定治疗的17例腰椎结核患者的临床资料。其中男10例，女7例；年龄20～69岁，平均42.6岁；病程1～6个月，平均3.4个月。病变节段：L₁ 5例，L₂ 6例，L₃ 3例，L₄ 3例。按美国脊髓损伤协会（ASIA）分级：C级2例，D级13例，E级2例。采用视觉模拟评分法（VAS）、日本矫形外科学会（JOA）评分及Barthel指数评价疗效，并计算JOA评分及Barthel指数改善率。定期行腰椎X线片及CT检查，评估腰椎后凸Cobb角矫正及植骨融合情况。
17例手术均顺利完成，病理检查确诊为结核。所有病例均获随访，随访时间24～48个月，平均35.3个月。腰椎X线片及CT显示坏死骨及脓肿清除彻底，所有病例腰椎后凸畸形矫正满意。术后6个月均获骨性融合，18个月均获临床治愈，随访期间无复发。未观察到内固定松动或断裂。末次随访时，2例ASIA分级由C级恢复至D级和E级，11例由D级恢复至E级，2例（D级）无变化。2例ASIA E级患者无神经功能缺损。术后2周及末次随访时VAS评分、JOA评分、Barthel指数及腰椎后凸Cobb角与术前比较差异均有统计学意义（P<0.05）。末次随访时JOA评分改善率为75.2%±6.2%，Barthel指数改善率为75.7%±10.8%。
极外侧入路病灶清除融合联合后路内固定是治疗腰椎结核的有效方法。
