摘要
[目的]了解L_5S_1节段脊柱结核前路病灶清除加植骨融合固定手术的治疗效果,为腰骶段结核手术治疗提供新的思路。[方法]回顾性分析本院脊柱外科2008年1月~2014年1月期间住院手术的腰骶段结核患者29例,男18例,女11例;平均年龄38.4岁(24~56岁),均合并腰及臀部疼痛症状。其中L_5结核6例、S_1结核3例,L_5S_1结核20例。病史平均4.3个月(3~6个月)。所有患者均行前路结核病灶清除术、植骨融合固定术。术后定期随访。比较术前和术后随访时患者症状改善程度(VAS评分、ODI功能障碍指数)、实验室检查指标变化以及植骨融合情况。[结果]所有患者均获得随访,平均手术时间(120±20)min,手术出血量(260±50)ml。术后3个月复查局部骨性融合者6例,6个月复查骨性融合者29例,随访1~4年[平均(1.8±0.3)年]未见局部骨不连、结核病灶复发、内固定断裂等并发症。手术前、后观察指标相比差异均有统计学意义(P〈0.05)。[结论]对于腰骶段脊柱结核病例,采用前路一期病灶清除及稳定性重建手术,可以达到彻底清除结核病灶及稳妥的固定,手术疗效肯定,并发症少,可以作为腰骶段结核手术治疗的一种方法选择。
[ Objective] To observe the therapeutic effect of anterior debridement, bone graft fusion, and fixation in the treatment of spinal tuberculosis at the L5 and S1 segments, and to provide a new idea for the surgical treatment of lumbosacral spinal tuberculosis. [ Methods] A retrospective analysis was performed in 29 patients ( 18 males and 11 females) with lumbosa- cral spinal tuberculosis who were hospitalized in Department of Spine Surgery in our hospital from January 2008 to January 2014. Their mean age was 38.4 years (24 -56 years) . All cases had low back and hip pain. Of the 29 cases, 6 had spinal tu- berculosis at the L5 segment, 3 had spinal tuberculosis at the $1 segment, and 20 had spinal tuberculosis at the L5 and S1 seg- ments. The mean history was 4. 3 months (3 -6 months) . All patients underwent anterior debridement, bone graft fusion, and fixation. After surgery, the improvement in symptoms (Visual Analogue Scale score and Oswestry Disability Index), the chan- ges in laboratory indices, and bone graft fusion were evaluated using the statistical analysis for paired data. [ Results ] All pa- tients were followed up for 1 -4 years (mean 1.8 ±0. 3 years) . The mean operation time was (120 ± 20) min, and the intrao- perative blood loss was (260 ± 50) ml. At 3 months after surgery, 6 patients achieved partial bony fusion. At 6 months after sur- gery, all 29 patients achieved complete bony fusion. No patients had complications, such as partial bone nonunion, recurrence of tuberculosis, or internal fixation fracture. All laboratory indices showed significant changes after surgery ( P 〈 0. 05 ) . [ Conclusion ] For patients with lumbosacral spinal tuberculosis, one - stage anterior debridement and reconstruction of stability can achieve thorough debridement and stable fixation. This method has a good surgical effect and causes few complications, so it can be used as a choice of surgical treatment for lumbosacral spinal tuberculosis.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2016年第23期2144-2147,共4页
Orthopedic Journal of China
关键词
脊柱结核
病灶清除术
前路
腰骶段
spinal tuberculosis, debridement, anterior approach, lumbosacral segment