一期病灶清除经椎弓根截骨内固定治疗腰骶段陈旧结核伴后凸畸形

Single-stage focal debridement and pedicle subtraction osteotomy for lumbosacral tuberculosis complicated with kyphosis deformity

中文关键词:  腰骶椎结核  结核后凸畸形  经椎弓根截骨  髂骨钉固定

英文关键词:Lumbosacral tuberculosis  Post-tubercular kyphosis  Transpedicular osteotomy  Iliac screw fixation

中文摘要:

  【摘要】 目的：探讨一期病灶清除经椎弓根截骨（pedicle subtraction osteotomy，PSO）内固定治疗腰骶段陈旧结核伴后凸畸形的临床疗效。方法：2002年2月～2010年6月我院采取一期病灶清除、PSO技术联合椎弓根螺钉及髂骨钉内固定治疗14例腰骶段陈旧结核伴后凸畸形患者，男5例、女9例，平均年龄45.2岁。术前及术后分别测量脊柱腰椎前凸角、腰骶角、后凸Cobb角及躯干矢状偏移距离，并行神经功能Frankel分级、疼痛视觉模拟评分（visual analogue scale，VAS）测定，随访观察治疗效果。结果：手术时间平均5.4h，术中出血平均2045ml。随访6个月~3年，平均23.4个月。术前腰椎前凸角、腰骶角、后凸Cobb角及躯干矢状面偏移距离分别为17.0°±8.4°、10.0°±6.1°、11.0°±4.7°、5.3±0.5cm，末次随访时分别为28.0°±7.9°、25.0°±7.6°、4.1°±3.5°、-3.2±0.8cm，矫正率分别为（52.0±4.2）%、（61.3±5.7）%、（68.3±3.6）%、（58.0±1.4）%。术前合并神经功能障碍Frankel C及D级各2例，末次随访时1例C级恢复到D级，其余均恢复至E级。术前VAS评分平均8.75分，末次随访时平均2.52分，疼痛改善率71.2%。所有病例均未出现死亡或神经损伤并发症，2例窦道形成、1例血肿形成，对症治疗后愈合；平均7.3个月植骨节段骨性融合。结论：一期病灶清除PSO内固定可安全有效地用于清除脊柱结核病灶，并同期完成后凸畸形矫正，可重建腰骶段稳定、恢复躯体矢状面平衡。

英文摘要:

  【Abstract】 Objective：To evaluate the clinical efficacy of single-stage focal debridement and pedicle subtraction osteotomy（PSO） for lumbosacral tuberculosis complicated with kyphosis deformity.Method：A total of 14 cases（5 males and 9 females） suffering from lumborsacral tuberculosis complicated with kyphotic deformity between 2002 and 2010 underwent one-stage focal debridement，PSO and pedicle-illiac screw fixation.The average age at surgery was 45.2 years（range，31-53 years）.Radiologic index including lumbar lordosis，lumbosacral angle，kyphotic Cobb angle，sagittal trunk shift as well as neurologic status using the modified Frankel grade and visual analogue scale（VAS） were evaluated before and after surgery.Result：The mean duration of surgery was 5.4h，and the average intraoperative blood loss was 2045ml.All patients were followed up for 6 to 36 months with an average of 23.4 months.At final follow-up，the lumbar lordosis increased from 17.0±8.4 degrees to 28.0±7.9 degrees.Lumbosacral angle increased from 10.0±6.1 degrees to 25.0±7.6 degrees.The average preoperative kyphosis was 11.0±4.7 degrees，which decreased to 4.1±3.5 degrees after operation.Sagittal trunk shift improved from 5.3±0.5cm to -3.2±0.8cm.The rate of correction for the four procedures mentioned above was （52.0±4.2）%，（61.3±5.7）%，（68.3±3.6）% and （58.0±1.4）% respectively.Three of four cases with Frankel′s C and D each had neurofunction improved to grade E after operation except for one grade C to grade D at final follow-up.The mean preoperative VAS score was 8.75 and 2.52 for final follow-up，and back pain relief reached 71.2%.No death or nerve injury was found.Two cases developed fistula formation and one had hematoma formation after operation.All patients showed bony union with an average of 7.3 months.Conclusion：Single-stage focal debridement and PSO is safe and reliable for debridement，deformity correction, stability reconstruction and maintaining sagittal alignment.