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后路经椎弓根固定合前路病灶清除植骨融合治疗腰骶部脊柱结核

摘要点击次数: 2353 全文下载次数: 1308 投稿时间：2006-10-31

作者	Author	单位	Address	E-Mail
陈建良	CHEN Jian-liang	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China	chjil8168@yahoo.com.cn
张龙君	ZHANG Long-jun	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China
郑晓东	ZHENG Xiao-dong	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China
王水桥	WANG Shui-qiao	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China
叶锋	YE Feng	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China
王晓	WANG Xiao	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China
张建军	ZHANG Jian-jun	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China
许勇	XU Yong	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China
陆建民	LU Jian-min	上虞市中医院,浙江上虞312300	Department of Orthopaedics,the Shangyu Hospital of TCM,Shangyu 312300,Zhejiang,China

期刊信息：《中国骨伤》2007年，第20卷，第9期，第622-624页

DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz

基金项目:

中文摘要:

目的:采用后路经椎弓根固定合前路病灶清除植骨融合治疗腰骶部脊柱结核,探讨后路钉棒系统内固定的可行性及后路手术的必要性。

方法:本组男8例,女4例;年龄42～64岁,平均52岁。12例均表现为持续的下腰痛,其中8例伴有单侧下肢痛,无明显潮热、盗汗等结核中毒症状。结核病灶累及L₄-L₅4例,L₅-S₁5例,L₄-S₁3例。5例伴双侧腰大肌脓肿,5例伴单侧腰大肌脓肿,2例未见明显脓肿影。病灶破坏最严重处均在L₅椎体。6例伴有腰骶角变小。8例CT检查提示,腰椎小关节增生内聚伴侧隐窝神经根管狭窄。术前常规化疗6～8周,常用链霉素、异烟肼、利福平和乙胺丁醇四联治疗,并加用氧氟沙星强化抗痨治疗1个月,每周复查血沉。一般血沉40mm/h,结核中毒症状有改善,体温低于37.5℃,营养不良基本纠正后进行手术治疗。所有患者均采用后路经椎弓根固定小关节突间植骨融合、前路病灶清除植骨融合术,其中有8例行侧椎管减压术。术后1～2周内采用异烟肼静脉给药,链霉素常规肌注,同时给予喹诺酮类药物以增强抗结核效果及预防混合感染,肛门排气恢复、进食后则予以利福平、乙胺丁醇口服给药,2周后改用术前用药。

结果:本组12例均获随访,随访时间10～24个月,平均18个月,按照结核治愈标准,所有患者结核症状消失,病灶全部治愈无复发。按Moon植骨成功后观测标准,本组病例植骨均愈合,愈合时间4～7个月,平均6.2个月。

结论:后路椎弓根固定稳定可靠,同时可行小关节突植骨、侧椎管减压、椎间植骨块加压固定有效避免植骨块松动。病椎椎弓根置入短螺钉可有效恢复脊柱正常序列,避免后期下腰痛的发生。

【关键词】结核,脊柱腰骶部内固定器骨科手术方法

Pedicle screw-rod internal fixation through posterior approach combined with debridement of the focus of infection through anterior approach and bone graft for the treatment of tuberculosis lumbosacral spine

ABSTRACT

Objective: To treat tuberculosis of lumbosacral spine with pedicle screw-rod internal fixation through posterior approach combined with debridement of the focus of infection through anterior approach and bone graft,so as to explore the feasibility of internal fixation with screw-rod system through posterior approach,and the necessity of posterior surgery.

Methods: Among 12 patients in the study,8 patients were male and 4 patients were female,ranging in age from 42 to 64 years,with an average of 52 years.All the patients had continuous lower back pain and no obvious hectic fever and night sweats,in which 8 patients had umlateral pain in the lower extremity.Focus of tuberculose involved L₄ to L₅ in 4 patients,L₅ to S₁ in 5 patients,L₄ to S₁ in 3 patients.Five patients had bilateral psoas abscess,5 paitents had unilateral psoas abscess,2 patients had no obvious abscess.The most serious focal damage was in L₅ vertebral body.Six patients had lumbosacral angle decreased.Eight patients performed regular CT scan,which showed hypertrophy of the lumbar Hacet joint combined with narrow nerve-root canal.Preoperative routine chemotherapy lasted for 6 to 8 weeks,and quadruple-drug therapy consisting of steptomycin, Isoniazid,rifampin and ethambutol was adopted,as well as Ofloxacin for a month to reinforce the treatment.The blood sedimentation was tested weekly.The operation was carried out when blood sedimentation rate decreased to 40 mm/h,symptom of poisoning improved,temperature was lower than 37.5 ℃,and malnutrition was corrected.All the patients were treated with pediculus screw-rod internal fixation through posterior approach combined with debridement of the focus of tuberculosis through anterior approach and bone graft,in which 8 patients underwent decompression of the lateral recess.At 1st or 2nd weeks after operation,follows methods were adoptd:Isoniazid was injected intravenously,streptomycin intramuscularly,and Quinolone was given to reinforce the anti-tubercculosis and to prevention mixed infection.After passage of flatus and the patients could eat,rifampin and Ethambutolwere administrated orally.Two weeks later,the drugs were changed to preoperative medication.

Results:All the patients were followed up and the duration of follow-up ranged from 10 to 24 months,with an average of 18 months.According to the healing criteria of tuberculosis,all the patients obtained tuberculosis symptoms disappeared,and tuberculous foci were treated completely without recurring.According to the criteria of Moon for successful bone graft,the grafting bones healed completely,and the heal time ranged from 4 to 7 months,meanly 6.2 months.

Conclusion: Pediculus screw-rod internal fixation through posterior approach is steady and reliable,at the same time bone grafting of the small joint and decompression of the lateral recess of the spinal canal,intervertebral bone grafting and compress fixation can efficiently avoid the lossing of the grafted bone.short-segment pedicle screw instrumentation is effective to restore the normal spinal sequence,and to avoid the occurrence of low back pain at later stage.

KEY WORDS Tuberculosis,spinal Lumbolacral region Internal fixators Orthopaedics operative methods

引用本文，请按以下格式著录参考文献：

中文格式:	陈建良,张龙君,郑晓东,王水桥,叶锋,王晓,张建军,许勇,陆建民.后路经椎弓根固定合前路病灶清除植骨融合治疗腰骶部脊柱结核[J].中国骨伤,2007,20(9):622~624
英文格式:	CHEN Jian-liang,ZHANG Long-jun,ZHENG Xiao-dong,WANG Shui-qiao,YE Feng,WANG Xiao,ZHANG Jian-jun,XU Yong,LU Jian-min.Pedicle screw-rod internal fixation through posterior approach combined with debridement of the focus of infection through anterior approach and bone graft for the treatment of tuberculosis lumbosacral spine[J].zhongguo gu shang / China J Orthop Trauma ,2007,20(9):622~624

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