摘要
目的探讨采用分期前后路联合手术治疗系统性红斑狼疮(SLE)合并脊柱结核治疗效果.方法1例已出现双下肢神经症状和大小便异常、X线片发现L3～4椎体终板破坏、椎间隙完全消失并向后成角的女性SLE患者,在正规抗痨药物治疗及激素保护下行两期手术治疗.第一期手术为后路L2～S1椎弓根螺钉系统内固定及L2～S1横突间和椎板自体髂骨植骨融合术;第二期手术行前路经腹膜外入路L3～4椎体前方冷脓肿清除、病灶死骨刮除及L3～4椎体间自体髂骨植骨融合.结果患者下肢麻木消失,肌力及大小便功能恢复正常.ESR及C反应蛋白值改善.结论分两期进行手术不仅有利于防止局部结核病灶扩散,而且能降低SLE的复发率和病死率.
Objective To investigate the treatment of tuberculous spondylitis associated with systemic lupus erythematosus （SLE） by staged anterior combining with posterior approach surgery. Methods A female patient with bilateral lower extremities neural symptom and difficulty in urination and defecation. The roentgenography revealed destruction of the end plates and completely loss of intervertebral space and kyphosis formation in L3-4. The first step was the posterior approach fixation of L2-S1 with pedicle screw system and autogenous bone graft fusion between transverse processes and laminae. The second step was the anterior approach to debridement of pyogenic tissue around L3-4 intervertebral space, and autogenous bone graft fusion of L3-4. Results The numbness and weakness of both legs disappeared. The urination and defecation function recovered. The value of blood sedimentation and C reactive protein was improved. Conclusions Staged surgery is beneficial to prevent the diffusion of tuberculosis and decrease the recurrence and mortality of SLE.
出处
《临床骨科杂志》
2005年第4期313-315,共3页
Journal of Clinical Orthopaedics
关键词
结核
脊柱
系统性红斑狼疮
腰椎
骨移植
融合术
tuberculosis, spine
systemic lupus erythematosus
lumbar vertebrae
bone transplantation
fusion
