Liu Fei, Shi Shi-Yuan, Zheng Qi, Shen Jian, Wang Yi-Fan, Cao Tian-Yi
Department of Orthopaedics, Hospital of Integrated Traditional Chinese and Western Medicine of Zhejiang Province, Hangzhou 310003, Zhejiang, China.
Zhongguo Gu Shang. 2020 Feb 25;33(2):166-72. doi: 10.12200/j.issn.1003-0034.2020.02.015.
To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis.
The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L to S. The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed.
All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively.
One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.
探讨一期后路病灶清除联合腰髂固定及植骨融合治疗腰骶部结核的临床疗效。
回顾性分析2013年1月至2018年2月采用一期后路病灶清除联合腰髂固定及植骨融合治疗的31例腰骶部结核患者的临床资料。其中男18例，女13例，年龄18～77岁，平均（45.9±9.1）岁。病变节段为L～S。术前ASIA分级：B级2例，C级17例，D级12例。分析术前、术后C反应蛋白（CRP）、视觉模拟评分法（VAS）、血沉（ESR）、ASIA分级、腰骶角及椎间隙高度，观察手术并发症、内固定稳定性及植骨融合情况。
31例患者均获随访，随访时间10～24个月，平均（16.0±3.1）个月。1例局部感染并皮下积液患者经换药治愈。其余30例均一期愈合，无窦道形成，脊柱结核无复发。所有患者均治愈，未发现内固定松动及断裂。所有植骨融合均成功，平均融合时间为（4.7±1.1）个月。末次随访时，ESR及CRP均正常，VAS由术前（6.13±1.21）分降至（1.92±0.57）分，ASIA分级：C级2例，D级6例，E级23例。末次随访时腰骶角及椎间隙高度分别由术前的（21.42±3.75）°、（7.84±0.41）mm增加至（27.21±3.12）°、（9.80±0.38）mm。
一期后路病灶清除联合腰髂固定及植骨融合是治疗腰骶部结核的一种可行、有效且安全的方法，可在临床推广应用。
