Zhang Jin, Wu Xinglin, Lu Tingsheng, Song Hui, Zhou Zhuojia, Li Bo
Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China.
Department of Spinal Surgery, Guizhou Provincial Orthopedic Hospital, Guiyang Guizhou, 550002, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Mar 15;33(3):296-301. doi: 10.7507/1002-1892.201809090.
To evaluate the safety and effectiveness of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis.
Between August 2011 and October 2014, 13 patients with lumbosacral tuberculosis were treated by one-stage posterior reserved posterior ligament complex, lesion debridement, bone graft fusion, and internal fixation via unilateral musculussacrospinalis iliac flap approach. There were 8 males and 5 females, aged from 22 to 57 years, with an average age of 35 years. The disease duration ranged from 2 to 19 months, with an average of 6.7 months. According to the American Spinal Injury Association (ASIA) classification criteria, the patients were graded as grade B in 2 cases, grade C in 4 cases, grade D in 5 cases, and grade E in 2 cases before operation. The preoperative Oswestry disability index (ODI) was 36.4±5.7; the preoperative lumbosacral angle was (20.7±0.7)°; the preoperative erythrocyte sedimentation rate (ESR) was (63.4±8.4) mm/1 h; and the preoperative C-reactive protein (CRP) was (38.8±5.2) mmol/L. The operation time and intraoperative blood loss were recorded. The ODI, ASIA grade, lumbosacral angle, and ESR were recorded at last follow-up. Bridwell criterion was used to judge the interbody fusion.
The operation time was 150-240 minutes (mean, 190 minutes), and the intraoperative blood loss was 420-850 mL (mean, 610 mL). No major blood vessel, dural sac, nerve root, and lumbosacral plexus injuries occurred during the operation. Delayed wound healing occurred in 3 cases, and primary wound healing achieved in the other patients. No wound infection or sinus formation was found. All 13 patients were followed up 1.5-6.1 years (mean, 2.8 years). During the follow-up period, there was no tubercular symptom, cerebrospinal fluid leakage, loosening and rupture of internal fixator; and no complications such as retrograde ejaculation and erectile dysfunction occurred in 8 male patients. Solid spinal fusion obtained in all patients with the mean fusion time of 6.4 months (range, 4.2-9.9 months); and all iliac osteotomies healed. At last follow-up, the ODI was 7.2±3.5, the lumbosacral angle was (31.2±0.5)°, and ESR was (9.8±2.5) mm/1 h, all of which improved significantly when compared with pre-operative ones ( <0.05). The patients were classified as grade D in 2 cases and grade E in 11 cases, which improved significantly when compared with preoperative ones ( =-3.168, =0.002).
One-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis is effective and safe.
评估经单侧骶棘肌髂骨瓣入路一期后路手术治疗腰骶部结核的安全性和有效性。
2011年8月至2014年10月，对13例腰骶部结核患者采用经单侧骶棘肌髂骨瓣入路一期后路保留后韧带复合体、病灶清除、植骨融合及内固定术。其中男性8例，女性5例，年龄22～57岁，平均35岁。病程2～19个月，平均6.7个月。术前按美国脊髓损伤协会（ASIA）分级标准：B级2例，C级4例，D级5例，E级2例。术前Oswestry功能障碍指数（ODI）为36.4±5.7；腰骶角为（20.7±0.7）°；红细胞沉降率（ESR）为（63.4±8.4）mm/1 h；C反应蛋白（CRP）为（38.8±5.2）mmol/L。记录手术时间及术中出血量。末次随访时记录ODI、ASIA分级、腰骶角及ESR。采用Bridwell标准判断椎间融合情况。
手术时间150～240分钟（平均190分钟），术中出血量420～850 mL（平均610 mL）。术中无大血管、硬脊膜囊、神经根及腰骶丛损伤。3例出现切口延迟愈合，其余患者切口一期愈合。未发现切口感染及窦道形成。13例患者均获随访，随访时间1.5～6.1年（平均2.8年）。随访期间无结核中毒症状、脑脊液漏、内固定松动及断裂；8例男性患者无逆行射精及勃起功能障碍等并发症发生。所有患者均获牢固脊柱融合，平均融合时间6.4个月（4.2～9.9个月）；所有髂骨截骨处均愈合。末次随访时，ODI为7.2±3.5，腰骶角为（31.2±0.5）°，ESR为（9.8±2.5）mm/1 h，与术前比较差异均有统计学意义（<0.05）。患者分级为D级2例，E级11例，与术前比较差异有统计学意义（=-3.168，=0.002）。
经单侧骶棘肌髂骨瓣入路一期后路手术治疗腰骶部结核安全有效。
