Department of Spine Surgery and Orthopaedics, The Xiangya Hospital of Central South University, Changsha, China.
Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Changsha, China.
Orthop Surg. 2021 Oct;13(7):2051-2060. doi: 10.1111/os.13150. Epub 2021 Sep 30.
To evaluate the medium-term outcomes of one-stage posterior lumbosacral or lumbopelvic fixation treatment of lumbosacral junction tuberculosis in adults.
This retrospective study enrolled a total of 38 adult patients (24 males and 14 females) with an average age of 48.0 ± 13.0 years (range, 25-75 years) during the period from February 2008 to July 2015. All patients were treated by one-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage. After pedicle screw or iliac screw fixation, a hemi-laminectomy or laminectomy was performed on the severely damaged side of the lesion segment. Intervertebral bone grafting and intertransverse bone grafting were performed after clearing the focus of tuberculosis. All cases were followed up for at least 5 years. Intraoperative blood loss, operative time, erythrocyte sedimentation rate (ESR), pain intensity was assessed by visual analog scale (VAS) score; neurological function was assessed by Japanese Orthopaedic Association (JOA) score; quality of life was assessed by Oswestry Disability Index (ODI); functional outcome, lumbosacral angle, and fusion time were gathered and analyzed. All data expressed as mean ± standard deviation.
During the 66.2 ± 4.4 months (range, 60-78 months) follow-up, all patients achieved clinical cure without severe complications. The intraoperative blood loss was 726.3 ± 151.9 mL (range, 400-1100 mL) and the operative time was 137.6 ± 22.5 min (range, 110-200 min). The ESR decreased to normal levels within (11.8 ± 2.6 mm/h) 3 months postoperatively. The VAS score significantly decreased from 6.8 ± 1.1 preoperatively to 0.8 ± 0.7 at the final follow-up (P < 0.01). The mean JOA improved from preoperative 18.5 ± 2.9 to 26.9 ± 1.1 at the last visit (P < 0.01). The mean ODI was 44.3 ± 6.7 and significantly decreased to 9.3 ± 1.9 at the final observation (P < 0.01). Patient-reported outcomes as measured by Kirkaldy-Willis criteria were excellent in 21 cases, good in 16 cases, and fair in one case; there were no poor outcomes. Lumbosacral angle increased from the preoperative values of 21.7° ± 1.8° to the postoperative values of 26.4° ± 1.4° (P < 0.01), with an angle loss of 1.2° ± 0.7° at the last follow-up. Bone fusion occurred on average 12.8 ± 1.9 months (range, 9-15 months) after surgery. No nonunion, pseudarthrosis, loosening or fracture of instruments occurred at the last follow-up.
One-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage according to the severity of sacral destruction is an effective and highly safe procedure to treat lumbosacral junction tuberculosis in adults.
评估一期后路腰骶或腰骶骨盆固定治疗成人腰骶结合部结核的中期结果。
本回顾性研究共纳入 2008 年 2 月至 2015 年 7 月期间 38 例成人患者（24 例男性，14 例女性），平均年龄 48.0±13.0 岁（范围，25-75 岁）。所有患者均采用一期后路清创、椎间融合、腰骶或腰骶骨盆固定及体位引流治疗。在椎弓根螺钉或髂骨螺钉固定后，对病变节段严重受损侧行半椎板切除术或椎板切除术。清除结核病灶后，行椎间植骨和横突间植骨。所有病例均至少随访 5 年。术中出血量、手术时间、红细胞沉降率（ESR）、疼痛强度采用视觉模拟量表（VAS）评分评估；神经功能采用日本矫形协会（JOA）评分评估；生活质量采用 Oswestry 功能障碍指数（ODI）评估；收集并分析功能结果、腰骶角和融合时间。所有数据均表示为均数±标准差。
在 66.2±4.4 个月（范围，60-78 个月）的随访期间，所有患者均无严重并发症而获得临床治愈。术中出血量为 726.3±151.9 mL（范围，400-1100 mL），手术时间为 137.6±22.5 min（范围，110-200 min）。ESR 在术后 3 个月内降至正常水平（11.8±2.6 mm/h）。VAS 评分从术前的 6.8±1.1 显著降至末次随访时的 0.8±0.7（P<0.01）。JOA 平均评分从术前的 18.5±2.9 提高至末次随访时的 26.9±1.1（P<0.01）。ODI 平均为 44.3±6.7，末次观察时显著降至 9.3±1.9（P<0.01）。采用 Kirkaldy-Willis 标准评估的患者报告结局为优 21 例、良 16 例、可 1 例；无差的结果。腰骶角从术前的 21.7°±1.8°增加到术后的 26.4°±1.4°（P<0.01），末次随访时丢失 1.2°±0.7°。术后平均 12.8±1.9 个月（范围，9-15 个月）发生骨融合。末次随访时无不愈合、假关节、内固定松动或断裂。
根据骶骨破坏的严重程度，一期后路清创、椎间融合、腰骶或腰骶骨盆固定及体位引流是治疗成人腰骶结合部结核的有效且高度安全的方法。
