| 耿晓林,贾金领.一期后路病灶清除植骨融合内固定术治疗腰椎结核.骨科,2016,7(3): 172-175. |
| 一期后路病灶清除植骨融合内固定术治疗腰椎结核 |
| One-stage posterior lumbar debridement, interbody fusion, and posterior instrumentation in treating lumbar spinal tuberculosis |
| 投稿时间：2015-07-04 |
| DOI：DOI：10.3969/j.issn.1674-8573.2016.03.007 |
| 中文关键词: 腰椎 结核，脊柱 脊柱融合术 |
| 英文关键词: Lumbar vertebrae Tuberculosis, spinal Spinal fusion |
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| 中文摘要: |
| 目的 评价一期经椎间隙行病灶清除植骨融合内固定术治疗腰椎结核的疗效及可行性。方法 2010年9月至2014年4月于我院诊治的33例脊柱结核患者，均为单间隙病变，累及2个椎体，采用经椎间隙行病灶清除植骨融合内固定治疗。术前进行2~3周常规抗结核治疗，并行X线、CT重建、MRI等影像学检查，拟定病椎椎弓根钉的进钉角度。记录患者的手术时间、出血量、血常规、生化检查结果、并发症、有无复发及腰部愈合情况；摄X线片了解植骨融合、脊椎生理曲度、内植物和植骨块位置；采用疼痛视觉模拟量表（visual analogue scale, VAS）评分评定患者手术前后的疼痛程度。结果 所有患者术后均经病理或细菌检查确诊。平均手术时间为（3.01±0.43） h，平均出血量为（366.52±74.13） ml。随访时间为12~48个月，未见病灶残留及复发。平均植骨融合时间为（8.14±1.25）个月，红细胞沉降率恢复正常的时间为（6.02±1.57）个月。术后3个月VAS评分为（1.24±0.31）分，较术前的（7.23±1.45）分下降明显，差异有统计学意义（t=23.207，P=0.000）。结论 对于术前无明显腰大肌脓肿的腰椎结核患者，应用抗结核药物治疗好转后，行一期后路经椎间隙病灶清除植骨融合内固定术效果良好，具有一定可行性。 |
| 英文摘要: |
| Objective To evaluate the efficacy and feasibility of one-stage posterior lumbar debridement and interbody fusion for lumbar spinal tuberculosis. Methods From September 2010 to April 2014, 33 patients who were diagnosed as having lumbar tuberculosis were subjected to one-stage posterior lumbar debridement and interbody fusion. All patients suffered from the single interstitial disease and two vertebrae were involved. Two- to three-week anti-tuberculosis treatment and lumbar spine X-ray, CT scan, MRI examination of pathologic vertebrae were administered in each patient before surgery. Operation time, blood loss, blood routine test results, biochemical test results, complications, recurrence and waist healing were recorded. Fusion, physiological curvature of spine, position of implant and bone block were observed by X-ray examination. The pain was assessed by visual analogue scale (VAS) score before and after surgery. Results All patients were diagnosed pathologically or bacteriologically. The mean operative time was (3.01±0.43) h and average blood loss was (366.52±74.13) ml. Follow-up time was 12 to 48 months and nobody complained of residual lesions, relapse. The average time of fusion and ESR returned to normal level were (8.14±1.25) and (6.02±1.57) months respectively. Postoperative VAS score (1.24±0.31) was decreased significantly compared to preoperation (7.23±1.45)(t=23.207, P=0.000). Conclusion One-stage debridement and intervertebral fusion with internal fixation is appropriate for tuberculosis patients who were improved after anti-TB treatment and had no psoas abscess. |
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