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