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[目的]探讨前侧改良倒“L”形切口、腹膜外入路病灶彻底清除、植骨联合后路内固定治疗多节段腰骶椎结核的临床疗效.[方法]回顾性分析2008年2月～2015年2月采用前后路联合手术治疗的多节段腰骶椎结核患者45例,其中男性28例,女性17例;平均年龄(47.00±14.60)岁.病变累及节段:L5～S115例,L3～S26例,L3～S15例,骨破坏均以L4-5,L5S1椎间隙为主;14例患者有神经根性症状,4例有马尾压迫症状.根据前路腹部切口不同,改良组26例采用改良倒“L”形前路切口,传统组19例采用传统前外侧切口.观察两组患者采用不同手术入路情况下,手术时间、术中出血量、疼痛评分、脊髓功能、脊柱矫形及相关并发症的情况.[结果]手术时间、术中出血量两组间差异无统计学意义(P＞0.05);改良组手术切口长度、术后首次肛门排气时间、术后疼痛VAS评分及术后住院时间均优于传统组,两组间差异有统计学意义(P＜0.05);术前、术后血沉及C反应蛋白两组间差异无统计学意义(P＞0.05).45例病例获得随访24～45个月,平均(32.00±10.21)个月,植骨融合率达100％,脊髓神经功能均获完全恢复,脊柱矫形Cobb角恢复情况及病灶治愈率两组间差异无统计学意义(P＞0.05).[结论]采用后路椎弓根钉固定联合前路改良倒“L”形切口腹膜外入路对多节段腰骶椎结核的治疗具有可操作性与实用性,该术式较传统入路具有手术创伤小、解剖显露清楚、胃肠道干扰小、术后并发症少、安全性高等优点.“,”[Objective] To compare the clinical outcomes of modified inverted “L”-shaped incision versus traditional anterolateral incision for anterior debridement combined with posterior fixation in surgical treatment of multiple segment lumbosacral tuberculosis.[Methods] A retrospective study was conducted on 45 patients with lumbosacral tuberculosis who received combined posterior and anterior surgeries from February 2008 to December 2012,including 28 males and 17 females with average age of (47.00± 14.60) years.The lesion involved L4 to S1in 15 patients,L3 to S2 in 6 and L3 to S1 in 5,with main bone destruction around the L4～5 and L5～S1 discs.Of them,14patients had symptoms of nerve root deficit and 4 had cauda equina compression.In term of anterior incision selected,26 patients underwent modified inverted “L”-shaped incision for debridement and bone graft after internal fixation with pedicle screw-rod system through a posterior midline incision (the modified group),while 19 patients was used conventional anterolateral incision for anterior debridement and bone graft following the posterior fixation (the conventional group).The operation time,blood loss,VAS,neurological function,laboratory tests and correction of spinal deformity measured on images were compared between the two groups.[Results] There were no significant differences in operation time and blood loss between the two groups (P＞0.05),however,the modified group had statistically decreased incision length,earlier flatus after operation,lower VAS and shorter hospital stay compared with the conventional group (P＜0.05).No statistical differences were noted in erythrocyte sedimentation rate and C-reaction protein between them.All the 45 patients were followed up for 24 to 45 months with an average of (32.00± 10.21) months.All patients got solid bony fusion,additionally,the patients who had neurologic deficit before operation got complete recovery of neurologic function at the latest follow up.There were no significant difference in correction rate of kyphosis and healing rate of the lesion between the two groups (P＞0.05).[Conclusion] The modified inverted “L”-shaped incision for anterior debridement and bone graft following posterior internal fixation is feasible and practicable for treatment of multiple lumbosacral tuberculosis,with advantages of minimal surgical intervention,clearer anatomic exposure,decreased gastrointestinal irritation,less complication and improved security over the conventional anterolateral incision.