前后路联合一期手术治疗腰骶段脊柱结核

Combining anterior and posterior at one stage surgical management for lumbar and sacrum spinal tuberculosis

摘要:

目的评价前后路联合一期手术治疗腰骶段脊柱结核的临床疗效.方法2001年1月～2004年1月间采用后路内固定并前路病灶清除椎体间植骨融合术治疗腰骶段脊柱结核患者38例.后路内固定采用椎弓系统,前路病灶清除后,采用自体髂骨移植26例,肽网植骨融合12例.结果除2例伤口延迟愈合、2例瘘道形成,行二期缝合愈合外,其余所有患者切口均一期愈合,其中36例获得随访,随访时间4个月一36个月.平均20个月,结核无局部复发,植骨界面骨性融合时间平均3.4个月.结论一期后路内固定前路病灶清除椎体间植骨融合术是治疗腰骶段脊柱结核的有效术式.

Abstract:

Objective: To evaluate the clinical efficacy of one-stage surgical management by combining anterior and posterior for lumbar and sacrum spinal tuberculosis. Methods: Thirty-eight patients with lumbar and sacrum spinal tubercuiosis were treated surgically by posterior instrumentation and anterior resection plus interbody autografting. Posterior instrumentation were used in transvertebral pedicle system. After anterior debridement autogarft was transplanted in 26 case, titanium cage bone transplanting were used in 12 cases. Results: All these patients had their incision healed by first intention except two incisions healing delayed and two forming fistula, which healed by delaying suture. All these patients were followed up from four months to thirty-six months (mean twenty months), No recurrence of spinal tuberculosis was found in any patient during the follow-up period. Spinal solid fusion at the interface between the graft and adjacent vertebral bodies were shown radiologically in 3.4 months on the average. Conclusion: One-stage surgical management by posterior instrumentation and anterior resection plus interbody autografting is an effective surgery to lumbar and sacrum spinal tuberculosis.