中国修复重建外科杂志

中国修复重建外科杂志

采用可扩张通道下病灶清除植骨融合联合后路内固定治疗腰椎结核

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目的 探讨采用可扩张通道下病灶清除植骨融合联合后路内固定治疗腰椎结核的临床疗效。 方法 回顾分析 2008 年 12 月—2014 年 12 月采用可扩张通道下病灶清除植骨融合联合后路内固定治疗的 17 例腰椎结核患者临床资料。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。病变累及节段:L1、2 5 例,L2、3 6 例,L3、4 3 例,L4、5 3 例。神经功能损害按美国脊髓损伤学会(ASIA)分级,C 级 2 例,D 级 13 例,E 级 2 例。采用疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、Barthel 指数评价疗效,并计算 JOA 评分和 Barthel 指数改善率;定期随访并复查腰椎 X 线片、CT,评价腰椎后凸 Cobb 角纠正情况及植骨融合情况。 结果 17 例患者手术均成功,术后病理检查均提示腰椎结核感染。所有患者均获随访,随访时间 24~48 个月,平均 35.3 个月。随访复查 X 线片及 CT 显示死骨清除彻底及椎旁脓肿消失,腰椎后凸 Cobb 角纠正良好。17 例患者术后 6 个月植骨均达骨性融合;随访期间未发现结核病灶复发,术后 18 个月结核病变均达到临床治愈。未发现内固定物松动、断裂等并发症。末次随访时,2 例术前 ASIA 分级 C 级患者中 1 例恢复至 D 级,1 例恢复至 E 级;13 例术前 D 级患者中 11 例恢复至 E 级,2 例无变化;2 例术前 E 级患者术后无神经损害。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 角均较术前明显改善,手术前后各时间点间比较差异均有统计学意义(P<0.05)。末次随访时,腰椎 JOA 改善率为 75.2%±6.2%,Barthel 指数改善率为 75.7%±10.8%。 结论 采用可扩张通道下病灶清除植骨融合联合后路内固定治疗腰椎结核临床疗效良好,是一种安全有效的治疗方法。

Objective To investigate the effectiveness of extreme lateral channel debridement and fusion combined with posterior fixation for lumbar spinal tuberculosis. Methods 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 L1, 2 in 5 patients, L2, 3 in 6 patients, L3, 4 in 3 patients, and L4, 5 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. Results 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 (P<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%. Conclusion To use extreme lateral channel debridement and fusion combined with posterior fixation is an effective treatment for lumbar spinal tuberculosis.

关键词: 腰椎结核; 可扩张通道; 后路内固定

Key words: Lumbar tuberculosis; extreme lateral channel; posterior fixation

引用本文: 陈树金, 马向阳, 杨进城, 杨敏, 邹小宝. 采用可扩张通道下病灶清除植骨融合联合后路内固定治疗腰椎结核. 中国修复重建外科杂志, 2017, 31(4): 455-460. doi: 10.7507/1002-1892.201612079 复制

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