周忠杰;宋跃明;李涛;刘立岷;龚全;

• 1:四川大学华西医院骨科

摘要(Abstract)：

[目的]探讨旁正中腹膜外入路在腰骶段脊柱结核手术中的应用及其临床疗效。[方法]2010年1月~2014年12月,应用旁正中腹膜外入路治疗腰骶椎结核患者共40例。其中男22例,女18例。平均年龄32.61岁。平均病程6.12个月。所有主要受累节段均为L5~S1,1例伴有L2椎体的跳跃性的小范围结核病灶,但不合并明显脓肿,1例伴有T5~7椎结核;1例向上累及到L4;3例向下累及到S2椎体;1例累及到S3椎体前份,1例累及S4。合并神经损害5例,均为Frankel D级。22例在该入路下完成固定融合,16例由该入路完成病灶清除及植骨,一期或二期后路短节段固定融合术。记录手术时间、术中失血量、手术并发症等,评估神经功能恢复情况、疼痛视觉模拟评分、腰骶角、植骨融合和结核病灶愈合情况。[结果]手术时间平均(197.44±54.37)min,失血量平均(315.10±72.05)ml。无血管、神经损伤并发症。5例术前有神经功能损害者均恢复正常,评定为Frankel E级。1例男性患者出现逆行射精。随访时间18~28个月。术后1年所有患者均达到植骨融合,无结核复发、内固定松动和断裂或植骨块的移位。VAS评分由术前(6.20±1.17)分显著减少至术后(1.88±0.98)分,进一步减少至末次随访时(0.80±0.73)分,三个时间点间差异均有统计学意义(P<0.05)。腰骶角由术前(110.63±8.10)°增加至术后(124.39±5.43)°,差异具有统计学意义(P<0.05);但末次随访时回落至(119.42±5.12)°,后两时间点间差异无统计学意义(P>0.05)。[结论]旁正中腹膜外入路可有效清除腰骶椎结核病灶,具有创伤小、并发症少、容易操作等优势。

关键词(KeyWords)： 腰骶椎结核;旁正中腹膜外入路;手术治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 周忠杰;宋跃明;李涛;刘立岷;龚全;

Email:

DOI:

参考文献(References)：

• [1]Jiang T,Zhao J,He M,et al.Outcomes and treatment of lumbosacral spinal tuberculosis:a petrospective study of 53 patients[J].PLo S One,2015,10(6):e0130185.
• [2]Rajasekaran S,Shanmugasundaram TK,Prabhakar R,et al.Tuberculous lesions of the lumbosacral region.A 15-year follow-up of patients treated by ambulant chemotherapy[J].Spine(Phila Pa1976),1998,23(10):1163-1167.
• [3]Moon MS,Kim SS,Moon YW,et al.Surgery-related complications and sequelae in management of tuberculosis of spine[J].Asian Spine J,2014,8(4):435-445.
• [4]Sun L,Song Y,Liu L,et al.One-stage posterior surgical treatment for lumbosacral tuberculosis with major vertebral body loss and kyphosis[J].Orthopedics,2013,36(8):1082-1090.
• [5]Li J,Li XL,Zhou XG,et al.Surgical treatment for spinal tuberculosis with bilateral paraspinal abscess or bilateral psoas abscess:one-stage surgery[J].J Spinal Disord Tech,2014,27(8):309-314.
• [6]Zhang HQ,Li JS,Guo CF,et al.Two-stage surgical management using posterior instrumentation,anterior debridement and allografting for tuberculosis of the lower lumbar spine in children of elementary school age:minimum 3-year follow-up of 14 patients[J].Arch Orthop Trauma Surg,2012,132(9):1273-1279.
• [7]Pang X,Wu P,Shen X,et al.One-stage posterior transforaminal lumbar debridement,360 degrees interbody fusion,and posterior instrumentation in treating lumbosacral spinal tuberculosis[J].Arch Orthop Trauma Surg,2013,133(8):1033-1039.
• [8]王栋,赵波,李锋涛,等.一期病灶清除固定融合治疗腰骶段脊柱结核的临床观察[J].中国矫形外科杂志,2016,24(23):2144-2147.
• [9]Song JF,Jing ZZ,Chen B,et al.One-stage anterolateral surgical treatment for lumbosacral segment tuberculosis[J].Int Orthop,2012,36(2):339-344.
• [10]赵刚,陈朝伟,汪浩广,等.一期病灶清除椎间植骨内固定治疗脊柱结核[J].中国矫形外科杂志,2012,20(21):1987-1990.
• [11]姜力元,胡建中,陈静,等.一期后路单侧椎板开窗、经椎间隙病灶清植骨融合内固定治疗胸腰段脊柱结核[J].中国矫形外科杂志,2016,24(11):990-994.
• [12]许建中,张泽华,周强,等.一期前路病灶清除植骨融合内固定治疗腰骶椎结核[J].中国脊柱脊髓杂志,2006,16(12):897-900.
• [13]肖联平,江毅,田永刚,等,前路经腹腔一期病灶清除植骨融合内固定术治疗腰骶段脊柱结核[J].中国修复重建外科杂志,2009,23(8):913-916.
• [14]朱泽章,邱勇,王斌,等.经腹直肌内缘腹膜外入路行L3~S1结核病灶清除术[J].中国脊柱脊髓杂志,2007,17(6):405-408.
• [15]Mukherjee SK,Dau AS.Anterior lumbar fusion in Pott's disease[J].Clin Orthop,2007,460(460):93-99.
• [16]Li JH,Zhang ZH,Shi T,et al.Surgical treatment of lumbosacral tuberculosis by one-stage debridement and anterior instrumentation with allograft through an extraperitoneal anterior approach[J].J Orthop Surg Res,2015,10(1):62.
• [17]马君,宋滇文,邵将,等.一期前后路联合手术治疗下腰椎结核[J].中国矫形外科杂志,2010,18(1):13-16.
• [18]李广州,钟德君,王清.单纯前路与一期前后路手术治疗腰骶椎结核[J].生物骨科材料与临床研究,2014,11(4):58-61.
• [19]He Q,Xu J.Comparison between the antero-posterior and anterior approaches for treating L5-S1vertebral tuberculosis[J].Int Orthop,2012,36(2):345-351.