同一体位下斜外侧腰椎椎间融合术联合经皮椎弓根螺钉内固定治疗腰椎结核

Single-position oblique lumbar interbody fusion combined with percutaneous pedicle screw internal fixation in the treatment of lumbar tuberculosis

中文关键词:  腰椎结核  斜外侧腰椎椎间融合术  同一体位  经皮椎弓根螺钉  内固定

英文关键词:Lumbar tuberculosis  Oblique lumbar interbody fusion  Single position  Percutaneous pedicle screw  Internal fixation

中文摘要:

  【摘要】 目的：探讨同一体位下斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）联合经皮椎弓根螺钉内固定治疗腰椎结核的可行性，并评估其临床疗效。方法：回顾性分析2018年9月~2019年12月我科采用OLIF联合经皮椎弓根螺钉内固定治疗的35例腰椎结核患者，其中男16例，女19例；年龄33~68岁（51.1±12.8岁）；术前术后均配合系统抗结核治疗。记录所有患者术前术后的C反应蛋白（C-reactive protein，CRP）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、手术时间、术中出血量、术后相关并发症、植骨融合情况，比较手术前后疼痛视觉模拟评分（visual analogue scale，VAS）、美国脊柱损伤协会（American Spinal Injury Association，ASIA）神经功能分级、Oswestry功能障碍指数（Oswestry disability index，ODI）、病变节段后凸Cobb角、腰椎前凸角。结果：所有患者均顺利完成手术，手术时间125~280min（168.8±51.4min）；术中出血量260~1500ml（347.5±121.7ml）。35例患者均获得随访，随访时间为24~48个月（37.8±8.9个月）；术后不同时间点（术后1、3、6个月及末次随访）ESR、CRP、VAS评分及ODI均较术前显著降低（P<0.05），术后不同时间点之间两两比较差异均有统计学意义（P<0.05）；术后不同时间点Cobb角及腰椎前凸角较术前显著降低（P<0.05），但术后不同时间点间两两比较无统计学差异（P＞0.05）。末次随访时13例神经损伤患者ASIA分级均较术前有不同程度的改善，所有患者均获骨性融合。2例患者于引流管口持续渗液合并窦道形成，予以换药、调整敏感抗结核药物及营养支持分别于术后3个月、术后5个月切口愈合；1例患者出现肺部感染合并胸腔积液，3例患者出现不同程度的药物性肝功能损伤，经药物保守治疗后好转。结论：同一体位下OLIF联合经皮椎弓根螺钉内固定治疗腰椎结核安全、可行，病灶清除彻底，骨融合率高，并具有创伤小、手术时间短、术后恢复快的优点。

英文摘要:

  【Abstract】 Objectives: To explore the feasibility and evaluate the clinical effect of single-position oblique lumbar interbody fusion(OLIF) combined with percutaneous pedicle screw internal fixation in the treatment of lumbar tuberculosis. Methods: 35 patients with lumbar tuberculosis treated in our department from September 2018 to December 2019 with OLIF and percutaneous pedicle screw internal fixation were retrospectively reviewed, including 16 males and 19 females, aged 33 to 68 years(51.1±12.8 years). All patients received systematic anti-tuberculosis treatment before and after operation. C-reactive protein(CRP) and erythrocyte sedimentation rate(ESR) before and after operation, and operation time, intraoperative blood loss, postoperative complications, and bone graft fusion were recorded. The visual analogue scale(VAS) of pain, American Spinal Injury Association(ASIA) impairment scale, Oswestry disability index(ODI), Cobb angle of diseased segments, and lumbar lordosis were compared between before and after operation. Results: All patients underwent the operation uneventfully, the operation time was 125 to 280 minutes(168.8±51.4 minutes), and the intraoperative blood loss was 260-1500ml(347.5±121.7ml). All the 35 patients were followed up for 24-48 months(37.8±8.9 months). The ESR, CRP, VAS score and ODI decreased significantly at different follow-up time points(1, 3, and 6 month and final follow-up) than those before operation(P＜0.05), and their respective pairwise comparisons of each follow-up time point were with significant differences(P＜0.05). The Cobb angle and lumbar lordosis angle at different follow-up time points after operation were significantly smaller than those before operation(P＜0.05), while there was no significant difference in pairwise comparison between each time point after operation(P＞0.05). At final follow-up, ASIA grade of 13 patients with nerve injury was improved to varying degrees compared with those before operation, and bony fusion was achieved in all patients. 2 patients occurred continuous exudation at the mouth of the drainage tube with sinus formation, who were given dressing changes, adjustments of sensitive anti-tuberculosis drugs and nutritional supports, the incision healed at 3 months and 5 months after operation, respectively; 1 patient developed pulmonary infection with pleural effusion and 3 patients had varying degrees of drug-induced liver function injury, and they improved after conservative drug treatment. Conclusions: Single-position OLIF combined with percutaneous pedicle screw internal fixation is safe and feasible for the treatment of lumbar tuberculosis, which has the advantages of complete debridement and high bone fusion rate as well as small trauma, short operation time and rapid recovery after operation.