关键词: 结核,脊柱, 腰椎, 清创术, 内固定器, 脊柱融合术, 治疗结果

Abstract:

Objective To evaluate the clinical efficacy of one-stage anterior debridement, bone grafting fusion and posterior cortical bone trajectory (CBT) screw fixation in combination with traditional pedicle screw internal fixation in lumbar single-segment instumentation for the treatment of monosegment lumbar spinal tuberculosis.Methods From January 2015 to January 2016, 42 patients with monosegment lumbar spinal tuberculosis in the First Affiliated Hospital of the Air Force Military Medical University of PLA were included in this analysis. All patients were divided into two groups based on the posterior internal fixation technique that was applied according to patient’s clinical situation and wish. Internal fixation was performed by CBT screws combined with traditional pedicle screws in 21 patients (A group) and by traditional pedicle screws in 21 patients (B group) after anterior debridement and bone grafting fusion. The Cobb angle, the Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and visual analogue score (VAS) value of all patients were analyzed before and after surgery and during the follow-up period.Results Forty-two patients were followed-up from 18 to 30 months, with an average follow-up time of (24.1±4.5)months. Three months after surgery, the ESR, CPR and VAS were (13.5±5.5)mm/1h, (4.7±2.0)mg/L and (1.9±0.8) in group A and (12.9±4.9)mm/1h, (5.2±3.2)mg/L and (2.2±1.0) in group B, respectively. The differences were not statistically significant (t=0.32, -0.68 and -1.02; P=0.747, 0.500 and 0.312). The average correction degree and correlation loss of Cobb angle were (11.6±6.3)° and (1.7±1.2)° in group A and (9.9±5.9)° and (1.4±1.1)° in group B at the last follow-up, with no significant statistical differences (t=0.96 and 0.94; P=0.343 and 0.355). As to postoperative neurological improvement, 1 case with Frankel grade B before operation recovered to grade D; of the 5 cases with grade C before operation, 4 cases recovered to grade D and 1 case recovered to grade E; of the 26 cases with grade D before surgery, all recovered to grade E.Conclusion For patients with monosegment lumbar spinal tuberculosis, CBT screw fixation technique can fix and fuse the diseased single-segment and retain normal movement of the adjacent spinal column. It is indicative to monosegment lumbar spinal tuberculosis.

Key words: Tuberculosis,spinal, Lumbar vertebrae, Debridement, Internal fixators, Spinal fusion, Treatment outcome