Liang Qiang, Pu Yu, Wang Qian, Shi Jiandang, Sun Guangwei, Liu Liehua, Jin Weidong, Wang Zili
Ningxia Medical University.
Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan.
Medicine (Baltimore). 2019 Mar;98(10):e14815. doi: 10.1097/MD.0000000000014815.
During the operation of treating lumbar tuberculosis in children, a long-segment or short-segment fixation, and fusion method were usually applied, which would adversely affect the function of normal motion unit. And so, we have been focusing on how we can shorten the range of fixation and fusion using intervertebral surgery. The objective of this retrospective study is to investigate the clinical outcome of intervertebral surgery, in the treatment of lumbar tuberculosis in children.From June 2003 to June 2013, 18 children with lumbar tuberculosis underwent intervertebral surgery, using a combined posterior and anterior approach, in our hospital. The surgical treatments included posterior pedicle screw fixation of affected vertebrae and posterolateral bone grafting, anterior debridement, compression, and strut bone grafting. Indicators such as preoperative and postoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, neurological function, visual analog scale (VAS) score, kyphotic Cobb angle, complications, healing of lesions, bone graft healing, and recurrence were statistically analyzed.The mean follow-up time was 86.5 months (range, 62-120 months). Three months after the operation, all patients' ESR and CRP levels decreased to normal, and both the American Spinal Injury Association neurological function scores and VAS scores improved. Successful bone graft healing was achieved, with lesions completely healed at 6 months after surgery, and no recurrence occurred. The preoperative kyphotic was 24.00° ± 13.15° (range -10°-39°), which decreased to -4.61° ± 7.31° (range -19°-10°) postoperative (Z = -4.34, P < .01); the mean deformity correction angle was 28.61° ± 8.43° (range 9°-43°). There was no significant difference between the kyphotic angle measured immediately after surgery at (-4.61° ± 7.31°) and the kyphotic angle measured at 5-year follow-up at (-3.11° ± 7.56°). The mean loss of correction was 1.50° ± 0.90°.Intervertebral surgery using a combined posterior and anterior approach is an effective and safe method for the treatment of lumbar tuberculosis in children. It can also preserve the function of normal motor segments to the maximum extent.
在儿童腰椎结核的手术治疗过程中，通常采用长节段或短节段固定及融合方法，这会对正常运动单元的功能产生不利影响。因此，我们一直致力于研究如何通过椎间手术缩短固定和融合的范围。本回顾性研究的目的是探讨椎间手术治疗儿童腰椎结核的临床疗效。
2003年6月至2013年6月，我院18例儿童腰椎结核患者接受了前后联合入路的椎间手术。手术治疗包括对受累椎体进行后路椎弓根螺钉固定及后外侧植骨、前路清创、加压及支撑植骨。对术前和术后红细胞沉降率（ESR）、C反应蛋白（CRP）水平、神经功能、视觉模拟评分（VAS）、后凸Cobb角、并发症、病变愈合、植骨愈合及复发等指标进行统计学分析。
平均随访时间为86.5个月（范围62 - 120个月）。术后3个月，所有患者的ESR和CRP水平均降至正常，美国脊髓损伤协会神经功能评分和VAS评分均有所改善。植骨成功愈合，术后6个月病变完全愈合，无复发。术前后凸角为24.00°±13.15°（范围 - 10° - 39°），术后降至 - 4.61°±7.31°（范围 - 19° - 10°）（Z = - 4.34，P <.01）；平均畸形矫正角度为28.61°±8.43°（范围9° - 43°）。术后即刻测量的后凸角（ - 4.61°±7.31°）与5年随访时测量的后凸角（ - 3.11°±7.56°）之间无显著差异。平均矫正丢失为1.50°±0.90°。
前后联合入路的椎间手术是治疗儿童腰椎结核的一种有效且安全的方法。它还能最大程度地保留正常运动节段的功能。
