摘要
目的探讨腰骶段结核不同手术方式的适应证及临床效果。方法回顾性分析我院1998年1月至2011年10月期间收治的112例L5～S3腰骶椎结核患者的外科治疗效果及治疗前后生存质量评分改善情况。112例患者按美国脊柱损伤协会（AmericanSpinalInjuryAssociation，ASIA）脊髓损伤分级标准：C级31例，D级32例，E级49例。病灶涉及L5～S1节段66例，L4、L5、S1多节段32例，L5～S1、S2节段14例。分别采用三种手术方式治疗：单纯后路组（41例），后路病灶清除植骨融合内固定术；单纯前路组（38例），前路病灶清除植骨融合内固定术；后前路联合组（33例），后路钉棒内固定＋前路病灶清除植骨融合术。术前、术后常规支持和抗结核治疗，并定期随访，对比分析三组患者手术前后红细胞沉降率变化、结核活动、植骨块融合、神经功能恢复和畸形矫正情况，评价手术疗效。结果单纯后路、单纯前路、后前路联合三组手术时间分别为（150±22）min，（140±18）min，（180±18）min，红细胞沉降率及C反应蛋白均在术后3个月恢复正常；术前生存质量总评分得分低（55．54±9．23），经过外科＋药物治疗后，生存质量总评分85．42±9．98，躯体维度、心理维度及社会维度评分均得到显著改善（P〉0．05）；术后脊髓损伤ASIA分级、腰骶角均较术前有明显改善。术后复发3例，内固定松动2例，断裂1例，经再次手术痊愈，植骨融合。结论腰骶部结核对患者生存质量影响大，外科干预治疗可以显著改善患者生存质量；积极手术治疗可缩短疗程，提高治愈率；分析患者MRI、CT特点，根据病灶位置选择病灶清理的手术入路，根据骨眭结构破坏程度和解剖特点，合理选择有效内固定，可以取得满意的临床效果。
Objective To evaluate the indications and clinical efficacy of the different surgical methods for lumbosacral tuberculosis. Methods 112 patients suffering from lumbosacral tuberculosis from January 1998 to October 2011 were reviewed retrospectively. Based on American Spinal Injury Association （ASIA） grading system, 31 case was classified as grade C, 32 as grade D and 49 as grade E. The affected locations were L5,S1 in 66 cases, L4-S1 in 32, and L5-S2 in 14 cases. 41 cases （posterior group） underwent posterior pedicle screw instrumentation, debridement and allograft; and 38 cases （anterior group） underwent one-stage anterolateral debridement plus allograft and internal fixation. 33 （posterior-anterior group） cases experienced posterior pedicle screw instrumentation and anterior debridement and allograft. All cases underwent routine support and anti-tuberculosis treatment before and after operation. The change of erythrocyte sedimentation rate （ESR）, signs of tuberculosis activity, graft fu- sion, neurological recovery and correction of deformity were evaluated in follow-up and compared among three groups. Results The average operating time in posterior, anterior and posterior-anterior group was （150±22） min, （140± 18） min, （180± 18） min re- spectively. ESR and C-reactive protein （CRP） were recovered to normal 3 months post surgery. The quality of life total score of lum- bosacral tuberculosis patients was very low （55.54 ± 9.23）. After surgery and drug treatment, the total score and each dimen- sion scores of the SF- 36 were significantly improved. Postoperative ASIA classification and lumbosacral angle were significantly improved. Tuberculosis recurrence occurred in three cases, fixation loosening in two cases, fixation fracture in one case, and all above cases were cured after revision surgery. The others all were cured and bone graft fusion was determined. Conclusion The quality of life of lumbosacral tuberculosis patients were impacted seriously, and which could be significantly improved with surgi- cal intervention. According to the patient MRI, CT characteristics, surgical approach selection was based on lesion location. Effec- tive internal fixation was based on the extent of damage in bone structure and anatomical characteristics. Following above princi- ples, satisfactory clinical results could be achieved.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2014年第2期143-148,共6页
Chinese Journal of Orthopaedics
关键词
腰骶部
结核
脊柱
治疗结果
Lumbosacral region
Tuberculosis, Spinal
Treatment outcome
