采用可扩张通道下病灶清除植骨融合联合后路内固定治疗腰椎结核

发布时间：2018-11-17 15:07

【摘要】：目的探讨采用可扩张通道下病灶清除植骨融合联合后路内固定治疗腰椎结核的临床疗效。方法回顾分析2008年12月-2014年12月采用可扩张通道下病灶清除植骨融合联合后路内固定治疗的17例腰椎结核患者临床资料。男10例,女7例;年龄20~69岁,平均42.6岁。病程1~6个月,平均3.4个月。病变累及节段:L_(1,2)5例,L_(2,3)6例,L_(3,4)3例,L_(4,5)3例。神经功能损害按美国脊髓损伤学会(ASIA)分级,C级2例,D级13例,E级2例。采用疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、Barthel指数评价疗效,并计算JOA评分和Barthel指数改善率;定期随访并复查腰椎X线片、CT,评价腰椎后凸Cobb角纠正情况及植骨融合情况。结果 17例患者手术均成功,术后病理检查均提示腰椎结核感染。所有患者均获随访,随访时间24~48个月,平均35.3个月。随访复查X线片及CT显示死骨清除彻底及椎旁脓肿消失,腰椎后凸Cobb角纠正良好。17例患者术后6个月植骨均达骨性融合;随访期间未发现结核病灶复发,术后18个月结核病变均达到临床治愈。未发现内固定物松动、断裂等并发症。末次随访时,2例术前ASIA分级C级患者中1例恢复至D级,1例恢复至E级;13例术前D级患者中11例恢复至E级,2例无变化;2例术前E级患者术后无神经损害。术后2周及末次随访时VAS评分、JOA评分、Barthel指数及腰椎后凸Cobb角均较术前明显改善,手术前后各时间点间比较差异均有统计学意义(P0.05)。末次随访时,腰椎JOA改善率为75.2%±6.2%,Barthel指数改善率为75.7%±10.8%。结论采用可扩张通道下病灶清除植骨融合联合后路内固定治疗腰椎结核临床疗效良好,是一种安全有效的治疗方法。
[Abstract]:Objective to evaluate the clinical effect of debridement and bone graft fusion combined with posterior internal fixation in the treatment of lumbar tuberculosis. Methods from December 2008 to December 2014, the clinical data of 17 patients with lumbar tuberculosis treated by debridement, bone grafting, fusion and posterior internal fixation under expandable channels were retrospectively analyzed. There were 10 males and 7 females, aged 20 to 69 years (mean 42.6 years). The course of disease was 1 ~ 6 months (mean 3.4 months). There were 5 cases of L _ (1), 6 cases of L _ (2), 3 cases of L _ (3), 3 cases of L _ (4) and 3 cases of L _ (4). According to the (ASIA) classification of the American Society of Spinal Cord injury, the neurological impairment was classified as C in 2 cases, D in 13 cases and E in 2 cases. Pain visual analogue score (VAS),) (JOA) score of Japanese Orthopedic Association (JOA) Barthel index were used to evaluate the efficacy and the improvement rate of JOA score and Barthel index were calculated. CT, was used to evaluate the correction of Cobb angle and bone graft fusion of lumbar kyphosis. Results all the 17 patients were successfully operated, and the postoperative pathological examination showed that the lumbar tuberculosis was infected. All patients were followed up for 24 ~ 48 months (mean 35.3 months). X-ray and CT showed that the dead bone was cleared completely, the paraspinal abscess disappeared, and the Cobb angle of lumbar kyphosis was corrected well. No recurrence of tuberculosis was found during follow-up. No complications such as loosening and fracture of internal fixation were found. At the last follow-up, 1 case recovered to grade D and 1 case returned to grade E in 2 patients with ASIA grade C before operation, 11 patients returned to grade E in 13 patients with grade D before operation, 2 patients did not change, and 2 patients with grade E before and after operation had no nerve damage. The VAS score, JOA score, Barthel index and Cobb angle of lumbar kyphosis were significantly improved at 2 weeks and the last follow-up after operation (P0.05). At the last follow-up, the improvement rate of JOA in lumbar spine was 75.2% 卤6.2% and the improvement rate of Barthel index was 75.7% 卤10.8%. Conclusion the treatment of lumbar tuberculosis with debridement and bone grafting combined with posterior internal fixation under expandable channels is a safe and effective method.
【作者单位】：广州军区广州总医院脊柱外科;广州中医药大学研究生院;
【基金】：广东省省级科技计划项目(2015B020233013)~~
【分类号】：R687.3

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