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中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (5): 457-462.doi: 10.3969/j.issn.1000-6621.2021.05.009

• 论著 • 上一篇    下一篇

通道下后方经椎间孔入路行病灶清除联合椎间植骨内固定术治疗腰椎结核的效果分析

薛海滨(), 罗小波, 孙飞, 简伟, 李金龙   

  1. 100091 北京,解放军总医院第八医学中心骨科
  • 收稿日期:2020-12-31 出版日期:2021-05-10 发布日期:2021-04-30
  • 通信作者: 薛海滨 E-mail:tornatorex@163.com

Analysis of clinical efficacy of posterior transforaminal debridement and interbody fusion with instrumentation via tubular retractor system for lumbar tuberculosis

XUE Hai-bin(), LUO Xiao-bo, SUN Fei, JIAN Wei, LI Jin-long   

  1. Department of Orthopedics, 8th Medical Center, the General Hospital of Chinese People’s Liberation Army, Beijing 100091, China
  • Received:2020-12-31 Online:2021-05-10 Published:2021-04-30
  • Contact: XUE Hai-bin E-mail:tornatorex@163.com

摘要:

目的 探讨在通道下后方经椎间孔入路行病灶清除联合椎间植骨内固定术治疗腰椎结核的临床疗效。 方法 收集2013年1月至2019年3月解放军总医院第八医学中心骨科收治的资料完整的采用通道下后方经椎间孔入路行病灶清除联合椎间植骨内固定术治疗的56例腰椎结核患者。患者病程2~6个月,平均(3.4±1.1)个月;均为1个椎间盘及对应椎体受累。通过对患者手术时间、术中出血量、手术前后血红细胞沉降率(ESR)、C反应蛋白(CRP)水平、疼痛视觉模拟评分(VAS)、Oswestry 功能障碍指数(ODI)、美国脊柱损伤协会(ASIA)分级、腰椎矢状位曲度(即病变部位前凸角度)变化、术后植骨融合情况和并发症发生情况进行统计分析,评价手术治疗效果。 结果 56例患者随访18~48个月,平均(21.5±5.8)个月;手术时间90~180min,平均手术时间(124.5±26.2)min;术中出血量150~400ml,平均出血量(248.4±46.7)ml。所有患者切口均一期愈合,2例术后1~2个月出现切口处窦道形成,经换药后愈合。至抗结核治疗结束时,56例患者ESR及CRP均恢复正常。至末次随访时,所有患者病灶均治愈,无复发患者;VAS评分、ODI、病变部位前凸角度分别为(0.68±0.15)分、(9.45±1.72)%和(5.40±1.40)°,较术前的(7.46±1.45)分、(75.84±9.61)%和(2.80±0.60)°均得到明显改善,差异均有统计学意义(t=34.805,P<0.001;t=50.889,P<0.001;t=-12.774,P<0.001)。4例ASIA分级为D级的截瘫者恢复至E级。56例患者术后6~10个月[平均(7.5±1.2)个月]植骨均获得骨性融合,随访期间无内固定物松动、断裂及移位等并发症发生。 结论 在通道下后方经椎间孔入路行病灶清除联合椎间植骨内固定术治疗腰椎结核疗效确切,是一种治疗腰椎结核微创可行的方法。

关键词: 结核, 腰椎, 病灶清除, 治疗结果

Abstract:

Objective To investigate the clinical efficacy of posterior transforaminal debridement and interbody fusion with instrumentation via tubular retractor system in the treatment of lumbar tuberculosis. Methods From January 2013 to March 2019, 56 lumbar tuberculosis patients treated with posterior transforaminal debridement and interbody fusion with instrumentation via tubular retractor system from Department of Orthopedics, 8th Medical Center, the General Hospital of Chinese People’s Liberation Army were retrospectively reviewed. Clinical data of all the patients were complete. The mean duration of symptoms was (3.4±1.1) months (range 2-6 months) in average and all patients had single motion segment involvement. The duration of operation, intraoperative blood loss, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) preoperative and postoperative, pain visual analogue scale (VAS), Oswestry disability index (ODI), ASIA stage, change of sagittal curvature of lumbar spine (lordosis angle of lesion site), bone graft fusion postoperative and complications were analyzed to evaluated the efficacy of the surgery. Results The mean follow-up was (21.5±5.8) months (range, 18 to 48 months), the mean duration of operation was (124.5±26.2) min (range, 90 to 180 min), the mean intraoperative blood loss was (248.4±46.7) ml (range, 150 to 400 ml). The incisions of all patients healed at the first stage. Sinus formation occurred in 2 cases 1-2 months postoperative, and healed after change of dressing and adjustment of anti-tuberculosis drugs. At the end of anti-tuberculosis treatment, both ESR and CRP of all the 56 patients returned to normal. At the last follow-up, all the patients were cured and no recurrence occurred. The VAS, ODI and lordosis angle of lesion site were significantly better than those preoperative ((0.68±0.15) vs. (9.45±1.72), t=34.805, P<0.001; (9.45±1.72) % vs. (75.84±9.61) %, t=50.889, P<0.001; (5.40±1.40)° vs. (2.80±0.60) °, t=-12.774, P<0.001, respectively). Four patients with ASIA grade D paraplegia had improvement to grade E. The bone graft was fused 6 to 10 months (mean, (7.5±1.2) months) after operation in 56 patients. There were no complications such as loosening, fracture or displacement of internal fixation during the follow-up. Conclusion Posterior transforaminal debridement and interbody fusion with instrumentation via tubular retractor system had good efficacy and was minimally invasive, it was a feasible method for the treatment of lumbar tuberculosis.

Key words: Tuberculosis, Lumbar vertebrae, Debridement, Treatment outcome