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目的:探讨一期后路钉钩棒短节段内固定、二期前路病灶清除植骨融合术治疗儿童下腰椎结核的手术方法及疗效。方法:2004年5月～2008年2月共收治儿童下腰椎结核患者9例,其中男5例,女4例,年龄5～11岁,平均7.8岁。术前腰椎局部前凸角-18°～4°,平均-8.6°±7.4°。均无明显的腰椎后凸畸形。病变累及一个椎体1例,累及2个椎体7例,累及3个椎体1例。术前神经功能Frankel分级:B级1例,C级3例,D级5例。均采用一期行后路短节段内固定,二期行前路病灶清除植骨融合手术治疗。观察比较术前、术后及末次随访时患者局部前凸角,评估植骨融合情况及神经功能恢复情况。结果:所有病例均获随访,随访时间30～53个月,平均41.0±7.8个月。术后腰椎局部前凸角5°～11°,平均8.8°±1.7°,较术前明显改善(P<0.05)。末次随访时腰椎局部前凸角为5°～10°,平均7.3°±1.7°,较术后无明显角度丢失(P>0.05)。1例末次随访时神经功能Frankel分级仍为D级,余患者神经功能均恢复至正常。随访期间无内固定松动及断裂,植骨获得满意融合,无结核复发。结论:对于无明显后凸畸形的儿童下腰椎结核患者,一期后路钉钩棒系统短节段内固定、二期前路病灶清除植骨融合术,是一种安全有效的治疗方法。
OBJECTIVE: To investigate the surgical methods and the curative effect of the treatment of pediatric lower lumbar tuberculosis in the first stage after the fixation of the short segment of the nail with the hook rod and the second stage anterior debridement and fusion with bone grafting. Methods: From May 2004 to February 2008, 9 cases of children with lower lumbar tuberculosis were treated, including 5 males and 4 females, aged 5 to 11 years (average 7.8 years). Preoperative lumbar lordosis angle -18 ° ~ 4 °, average -8.6 ° ± 7.4 °. No obvious lumbar kyphosis. Lesions involving a vertebral body in 1 case, involving 2 vertebral body in 7 cases, involving 3 vertebral body in 1 case. Frankel classification of preoperative neurological function: grade B in 1 case, grade C in 3 cases, grade D in 5 cases. All the patients were treated with one-stage posterior short segment fixation and two-stage anterior debridement and bone grafting and fusion surgery. To observe and compare the local lordosis angle before, after and at the last follow-up to evaluate the bone graft fusion and neural recovery. Results: All cases were followed up for 30-53 months with an average of 41.0 ± 7.8 months. The lumbar lordosis angle was 5 ° ~ 11 ° with an average of 8.8 ° ± 1.7 °, which was significantly improved compared with that before operation (P <0.05). At the final follow-up, the lumbar lumbar lordosis angle was between 5 ° and 10 ° with an average of 7.3 ° ± 1.7 °, with no significant angle loss (P> 0.05). In the last follow-up, the Frankel grade of neurological function was still grade D, and the neurological function of the remaining patients returned to normal. During the follow-up period, no internal fixation loosening and fracture, satisfactory fusion of bone graft, no recurrence of tuberculosis. Conclusion: For patients with lower lumbar tuberculosis without obvious kyphosis, a simple and effective method for the treatment of children with lumbar tuberculosis without obvious kyphosis after a period of short screw fixation system and anterior debridement and anterior grafting fusion is a safe and effective treatment.