经腹直肌腹膜外入路在下腰椎结核治疗中的应用

Rectus abdominis extraperitoneal approach for lower lumbar spinal tuberculosis

中文关键词:  腹膜外入路  腹直肌  下腰椎结核  治疗

英文关键词:Extraperitoneal approach  Rectus abdominis  Lower lumbar tuberculosis  Treatment

中文摘要:

  【摘要】 目的：探讨应用经腹直肌腹膜外入路治疗下腰椎结核的疗效。方法：自2008年9月～2013年1月，对15例下腰椎结核患者采用脐旁水平腹部正中直切口，向一侧牵开腹直肌，经腹直肌腹膜外入路，从腰大肌内侧缘开始显露腰椎，透视下定位病椎，显露病灶。死骨及脓肿清除满意后，修整残留的上下病椎，椎间隙一期植入带三层骨皮质的髂骨块；10例采用联合后路内固定术。观察平均手术时间、平均手术出血量，统计术前及术后血沉及C反应蛋白。影像学评估手术前后Cobb角矫正情况及椎体间植骨融合情况。按Chen等标准进行疗效评定。结果：本组随访 6～52个月。单纯前路病灶清除及椎体间植骨平均手术时间为120min，平均出血量为300ml；结合后路内固定术者，平均手术时间为256min，平均出血量为380ml。所有病例血沉及C反应蛋白在术后2～4周内降至正常。后凸畸形患者，后凸角度平均矫正16°，畸形矫正满意。所有患者椎体间植骨4～6个月均融合。按Chen等的疗效评定标准，本组优10例，良4例，中1例，优良率为93.3%。结论：经腹直肌腹膜外入路治疗下腰椎结核，具有操作便捷、创伤小、显露充分、并发症少等优点，值得临床推广应用。

英文摘要:

  【Abstract】 Objectives: To evaluate the surgical outcome of rectus abdominis extraperitoneal approach for lower lumbar spinal tuberculosis. Methods: From September 2008 to January 2013, 15 cases with lower lumbar spinal tuberculosis underwent this surgery. The rectus abdominis was pulled to one side, lumbar vertebra was exposed from the medial edge of the psoas muscle via rectus abdominis extraperitoneal approach. The involved vertebra as well as the lesion was exposed under fluoroscopy. Debridement and removal of dead bone was performed. After that, instrumentation was applied in 10 cases. The mean operation time and the average blood loss, erythrocyte sedimentation rate(ESR) and C-reactive protein were recorded before and after surgery. The rate of correction of Cobb′s angle before and after surgery and fusion status were evaluated by radiography. Efficacy was evaluated according to Chen criteria. Results: All cases were followed up for 6 to 52 months. The mean operation time was 120 minutes and the average blood loss was 300ml for cases undergoing anterior approach alone. The average operation time was 256 minutes and the average blood loss was 380ml for cases undergoing anterior and posterior approach. ESR and C-reactive protein decreased to normal level 2 to 4 weeks after operation in all cases. The average kyphosis correction was 16° in cases with combined approach. All cases reached bony fusion 4 to 6 months after operation. According to Chen criteria for efficacy evaluation, excellent was noted in 10 cases, good in 4 cases, fair in 1 case, with a good rate of 93.3%. Conclusions: The rectus abdominis extraperitoneal approach is minimal invasive and simple, and worthy of clinical application for lower lumbar spinal tuberculosis.