前后路联合手术治疗腰骶椎结核修改稿.docVIP

前路病灶清除椎体间植骨结合后路椎弓根内固定治疗腰骶椎结核 温州医科大学附属温岭医院脊柱外科(317500) 李宏杰 张文斌 莫挺挺 方春养 【摘要】 目的：探讨前路病灶清除椎体间植骨结合后路椎弓根内固定治疗腰骶段结核的临床疗效。方法：回顾性研究2005 年1 月~ 2012 年 6 月收治的18例腰骶椎结核患者，其中单纯腰痛2例，腰痛伴下肢放射痛3例，下肢肌力感觉减退者13例，神经功能Frankel分级：C级3例，D级10例，E级5例，病灶部位L4/5 8例，L54例，L5S16例。术前腰骶角15°~27°，血沉45~93mm/h。均采用前路病灶清除椎体间植骨结合后路椎弓根内固定治疗，应用腰骶角测量、血沉检测和神经功能 Frankel分级来评论临床疗效，随访观察治疗结果。 结果：本组18 例均获随访，随访时间14 ~22 个月，手术平均时间180 min ；出血量 400 ~800 ml，术中一例发生髂静脉损伤，术后4例出现不同程度腹胀，无脊髓损伤及其他严重并发症，腰腿痛症状均消失，Frankel分级有不同程度提高，X 线、CT检查显示本组患者均于术后 9 ~ 13 个月植骨融合，腰骶角和血沉末次随访时与术前比较均显著改善（P0.05）。结论：前路病灶清除椎体间植骨结合后路椎弓根内固定是治疗腰骶椎结核的一种有效手术方法。 【关键词】 腰骶椎结核 病灶清除 植骨 椎弓根 内固定 Surgical treatment of lumbosacral tuberculosis by anterior debridement, bone graft, and posterior pedicle screw-rod internal fixation./LI Hongjie, ZHANG Wenbing, MO Tingting, et al. Department of Spine Surgery ,Wenling hospital affiliated to Wenzhou medical university, Zhejiang, 317500, P.R.China. 【Abstract】 Objective To investigate the effectiveness of anterior debridement, bone graft, and posterior pedicle screw-rod internal fixation in the treatment of lumbosacral tuberculosis. Methods 18 patients with lumbosacral tuberculosis from January 2005 to June 2012 undergoing the surgical treatment by anterior debridement, bone graft, and posterior pedicle screw-rod internal fixation were reviewed retrospectively. Of these cases, L4/5 was involved in 8 cases, L5 in 4 cases and L5S1 in 6 cases. 2 cases complained of low back pain, 3 cases complained of radiopathic leg pain and 13 cases complained of incomplete paraplegia. The lumbosacral angle was 15~27° and the erythrocyte sedimentation rate (ESR) was 45~93 mm/h. The clinical indexes including the lumbosacral incidence, Frankel grade and ESR were reviewed at follow-up. Results All 18 cases were followed up 14~22 months. The mean operation time was 180 minutes. The amount of bleeding was 400~800 ml. Except one case,s iliac vein injuried and four cases with abdominal distension, no relative complication occurred and neurologic funct