【摘要】 目的 :探讨Ⅰ期行前路小切口沿肌间隙入路病灶清除联合后路病椎置钉固定治疗腰椎结核的临床疗效及优越性。方法:回顾性分析2010年2月至2014年2月治疗的82例腰椎结核患者,男50例,女32例;年龄17~84岁,平均50.5岁。根据术式不同分为两组,A组49例,行Ⅰ期前路小切口沿肌间隙入路病灶清除联合后路内固定术;B组33例,行Ⅰ期前路传统腹膜外入路病灶清除联合后路内固定术。对术后肛门首次排气时间,手术前后及末次随访Cobb角、视觉模拟评分(VAS)、红细胞沉降率(ESR)、Frankel分级进行统计分析,并观察手术并发症、内植物稳定性和植骨融合情况。结果:术后82例患者均获随访,时间15~36个月,平均23.7个月。术后3个月随访时发现4例(A组3例,B组1例)前路手术对侧腰大肌脓肿增大,行二次手术排脓后治愈。余78例均Ⅰ期愈合,无窦道形成、切口疝、脑脊液漏、脊柱结核复发等发生。植骨块骨性融合时间3~7个月,平均4.6个月。术后肛门排气时间A组较B组早,术后VAS评分A组优于B组,两组末次随访时Cobb角、ESR和Frankel分级较术前均明显改善。结论:根据病椎的破坏程度采用前路小切口病灶清除植骨联合后路椎弓根螺钉固定治疗腰椎结核是较为安全、有效的方法。更多还原

【Abstract】 Objective:To explore clinical outcomes and advantages of anterior small incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal tuberculosis. Methods:From February2010 to February 2014,totally 82 patients with lumbar spinal tuberculosis were treated by posterior individual fixation with small incision focus debridement,including 50 males and 32 females with an average of 50.5 years old. All patients were divided into two groups according to different procedures. Forty nine patients in group A were treated with anterior small incision focus debridement with posterior internal fixation through muscle spa ring at stage Ⅰ; and 33 patients in group B were treated with focus debridement with posterior internal fixation by extraperitoneal approach at stage Ⅰ. Postoperative mechanical ventilation time,preoperative and postoperative Cobb angle,visual analogue scale(VAS),erythrocyte sedimentation rate(ESR) and Frankel grading were observed and compared. Postoperative complications,stability of internal fixation and bone union were compared. Results:All patients were followed-up from 15 to 36 months with an average of 23.7 months. Psoas abscess of three patients in group A and 1 patient in group B on the opposite side increased and were healed by the secondary apocenosis. The other 78 cases were healed at stage Ⅰ,and no sinus tract formation,incisional hernia,leakage of cerebrospinal and occurrence of spinal tuberculosis were occurred. Fracture healing time ranged from 3 to 7 months with an average of 4.6 months. Postoperative mechanical ventilation time and VAS score in group A was better than group B. There were no statistical differences in Cobb angle,ESR and Frankel grading at the final following up between two groups. Conclusion:Anterior small incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal according to degree of damage is a safe and effective method.更多还原