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目的总结前路经腹腔一期病灶清除植骨融合内固定治疗腰骶段脊柱结核的临床疗效。方法2002年2月-2007年4月,采用经腹腔入路一期病灶清除,取2块大小为5cm×3cm的髂骨植骨及内固定治疗腰骶段结核16例,其中男4例,女12例;年龄27～63岁,平均38岁。病程6～18个月,平均10个月。均有不同程度腰骶部疼痛和结核中毒症状,9例伴下肢放射痛,3例鞍区麻木。2例曾按腰椎间盘突出诊治。结核受累节段均为L5、S1。血沉47～89mm/h,平均61mm/h。影像学检查诊断为脊柱结核。术前使用四联抗结核及营养神经支持治疗,待结核中毒症状改善或血沉呈下降趋势,肝、肾功能基本正常后行手术治疗。结果患者均安全完成手术,术中未出现腹腔脏器、大血管、马尾神经及输尿管损伤。术后切口均Ⅰ期愈合,结核无复发,无窦道形成。16例均获随访,随访时间12～37个月,平均21个月。无结核性腹膜炎、肠梗阻等并发症发生。4例男性患者均无勃起功能障碍、逆行射精等症状。术后3～6个月血沉恢复正常,定期复查X线片及CT,未见植骨块移位。患者术后12个月均获骨性融合,无钛板、螺钉断裂或松动发生。下肢放射性疼痛、鞍区麻木症状消失。仅有4例髂骨供骨区疼痛,2例轻度腰骶部疼痛,对症处理后疼痛缓解。按Chen等疗效评定标准:优14例,良2例。结论前路经腹腔一期病灶清除植骨融合内固定治疗腰骶段脊柱结核,可获得良好的骨性融合,重建脊柱稳定性。
Objective To summarize the clinical effect of anterior debridement, fusion, internal fixation with lumbosacral spine tuberculosis. Methods From February 2002 to April 2007, a total of 16 cases of lumbosacral tuberculosis were treated by iliac bone grafting and internal fixation with a size of 5cm × 3cm. Four of them were male, 12 females; aged 27 to 63 years old, average 38 years old. Course of 6 to 18 months, an average of 10 months. There are varying degrees of lumbosacral pain and symptoms of tuberculosis, 9 patients with lower limb radiating pain, 3 cases of sellar numbness. 2 cases have been diagnosed by lumbar disc herniation. Tuberculosis affected segments are L5, S1. ESR 47 ~ 89mm / h, an average of 61mm / h. Imaging diagnosis of spinal tuberculosis. Preoperative use of quadruple anti-TB and nutritional nerve support treatment until symptoms of tuberculosis or ESR decline, liver and kidney function was normal after surgery. Results All patients underwent surgery safely. Abdominal viscera, blood vessels, cauda equina and ureteral injury did not occur during operation. Postoperative incision healed by first intention, no recurrence of tuberculosis, no sinus formation. All 16 patients were followed up for 12 to 37 months with an average of 21 months. No tuberculous peritonitis, intestinal obstruction and other complications. 4 cases of male patients without erectile dysfunction, retrograde ejaculation and other symptoms. Erythrocyte sedimentation rate returned to normal after 3 ~ 6 months after surgery. X - ray and CT were reviewed regularly. No bone graft was found. Patients were bone fusion 12 months after surgery, no titanium plate, screw fracture or loosening occurred. Radiological pain in lower extremities, sedation symptoms disappeared. Only 4 cases of iliac bone for bone pain, 2 cases of mild lumbosacral pain, pain relief after symptomatic treatment. According to the Chen et al evaluation standard: excellent in 14 cases, good in 2 cases. Conclusion Anterior peritoneal debridement, fusion, internal fixation with lumbosacral spine tuberculosis can obtain good bony fusion and reconstruct spinal stability.