【摘要】 目的 探讨一期前路病灶清除、植骨融合联合后路单节段固定治疗腰椎结核合并椎体严重骨缺损的可行性及临床疗效。方法 回顾分析2020年6月至2023年6月我院脊柱外科收治的26例伴有椎体骨缺损腰椎结核患者的临床资料，其中男19例，女7例；年龄20～69岁，平均(39.00±15.38 )岁。所有患者均行一期前路病灶清除、植骨融合联合后路单节段固定。记录手术时间、出血量、并发症发生情况；比较手术前后疼痛视觉模拟评分(visual analogue scale,VAS )、Oswestry功能障碍指数(Oswestry disability index,ODI )和神经功能Frankel分级；分析C反应蛋白(C-reactive protein,CRP )、红细胞沉降率(erythrocyte sedimentation rate,ESR )及Cobb’s角、椎间融合等影像学参数，评价手术临床疗效。结果 26例患者均完成手术并获得12～33个月随访，平均(18.42±5.23 )个月。手术时间140～240 min，平均(166.15±27.58 ) min；出血量90～440 ml，平均(230.00±96.42 ) ml。术后1个月、6个月及末次随访VAS评分均较术前明显下降，末次随访时ODI较术前均有所改善，末次随访Frankel神经功能分级：D级2例，E级24例。所有患者末次随访时CRP和ESR均恢复正常。Cobb’s角由术前的(9.31±3.16 )°改善至(3.23±1.39 )°，末次随访时(3.42±1.53 )°，无明显角度损失，末次随访椎体间植骨术后均获得融合。随访期间腰椎结核复发患者1例，引流后治愈，无内固定失败患者。结论 一期前路病灶清除、植骨融合联合后路单节段固定是治疗腰椎结核合并椎体骨严重缺损安全有效的手术方法，手术效果良好。更多还原

【Abstract】 Objective To evaluate the feasibility and outcomes of the treatment for lumbar tuberculosis with severe vertebral bone defect by one-stage anterior debridement, bone grafting fusion and posterior single segment fixation. Methods The retrospective study evaluated the clinical data of 26 patients with lumbar spinal tuberculosis with vertebral bone defect admitted to the Department of Spine Surgery from June 2020 to June 2023. There were 19 males and 7 females, aged 20 to 69 years, with an average age of(39.00 ± 15.38) years. All patients were treated with one-stage anterior debridement, bone grafting fusion and posterior single segment fixation. The demographics, disease characteristics, duration of the operation, blood loss and complications were recorded and investigated. Preoperative and postoperative visual analog scale(VAS), Oswestry disability index(ODI) and Frankel scale were compared to evaluate the symptoms and neurological function. C-reactive protein(CRP) levels, erythrocyte sedimentation rate(ESR) and imaging parameters were recorded to investigate clinical efficacy. Results The average period of follow-up was(18.42 ± 5.23) months(range: 12-33 months). The duration of the operation was(166.15 ± 27.58) min(range: 140-240 min) and the blood loss was(230.00 ± 96.42) ml(range: 90-440 ml). The VAS scores at postoperative 1 month, 6 months and final follow-up were significantly lower than the preoperative data. The ODI at follow-up was improved compared with that preoperatively. At the last follow-up, neurological functions of 2 patients recovered to grade D, other patients recovered to grade E. CRP and ESR returned to normal at final follow-up in all patients. The Cobb’s angles were decreased from preoperative(9.31 ± 3.16) ° to(3.23 ± 1.39) °, and(3.42 ± 1.53) ° at final follow-up, without obvious angle loss at final follow-up. Fusion was achieved after intervertebral bone grafting at the last follow-up. During the follow-up, 1 patient with recurrent lumbar tuberculosis was cured after drainage. No internal fixation failure was observed. Conclusions One-stage anterior debridement, bone grafting fusion and posterior single segment fixation are probably feasible and effective for patients with lumbar spinal tuberculosis and severe bone defect.更多还原