髂骨螺钉联合磷酸钙骨粉在腰骶椎结核中的应用

doi:10.13418/j.issn.1001-165x.2015.03.025

摘要/Abstract

摘要：

目的　探讨后路病灶清除、髂骨螺钉联合椎弓根螺钉内固定、抗生素-磷酸钙骨粉填充椎间隙的方法治疗腰骶椎结核。方法　回顾性分析42例腰骶椎结核患者两种不同手术方法的临床资料，男19例，女23例，年龄19~75岁，平均38岁。病变节段为L4/5~S1/2，术前后凸成角5°~18°，平均9°。治疗组21例经后路一期病灶清除、髂骨螺钉联合腰椎椎弓根螺钉内固定、椎间隙及骨缺损区填充抗生素/磷酸钙骨粉；对照组21例采用前路病灶清除、自体髂骨植入和椎体钉棒固定。随访6个月~2年，平均12个月。结果　术后治疗组3~6个月骨缺损区修复、植骨融合，平均融合时间4个月；对照组融合时间5~9个月，平均7个月。治疗组术后后凸成角0~4°，平均2°；对照组术后后凸成角3~11°，平均7°(P＜0.05)。疗效按Chen 等标准评定，治疗组优17例，良2 例，总优良率90.5%; 对照组优13例，良3例，总优良率76.2%。术后末次随访结果显示脊柱病变节段稳定，病例无复发。结论　一期后路病灶清除、抗生素-磷酸钙骨粉填充椎间隙及骨缺损区、髂骨螺钉联合椎弓根螺钉内固定重建脊柱稳定的方法治疗腰骶椎结核是一种有效的手术方式。

关键词: 腰骶椎结核, 病灶清除, 磷酸钙, 髂骨钉, 固定

Abstract:

Objective To investigate a surgical treatment of lumbosacral tuberculosis by posterior debridement and internal fixation with iliac screws and pedicle screw, filling bone defects and intervertebral space with antibiotics&calcium phosphate. Methods A retrospective analysis of the clinical data was performed in 42 cases of lumbosacral tuberculosis patients (19 cases of male and 23 cases of female; age:19 to 75 year-old with an average of 38 years old) treated with two different surgical methods. Twenty-one patients with lumbosacral tuberculosis in the treatment group were treated by a single-stage posterior debridement and internal fixation with iliac screws and pedicle screws. Bone defects and intervertebral space filled with antibiotics-calcium phosphate were performed in these cases. 21 patients in the control group were implemented with anterior debridement and autogenous ilium grafts and vertebral pedicle screw fixation. All patients were followed up with an average of 12 months. Segmental lesions were L4/5~S1/2. 42 patients had varying degrees of kyphosis. The preoperative kyphosis angle was 5°~18° with an average of 9°. Results After operation, spinal fusion was achieved in treatment group. Bone graft fusion time was 3 to 6 months with an average of 4 months, and that of control group ranged from 5 to 9 months with an average of 7 months. Postoperative imaging results showed that kyphosis was partly corrected. The postoperative kyphosis angle in the treatment group was 0~4° with a mean of 2°, but the postoperative kyphosis angle in the control group was 3°~11° with an average of 7° (P＜0.05). According to Chen score, among the 21 cases in the treatment group, the therapeutic efficacy was excellent in 17 patients, good in 2 patients. the excellent & good rate was 90.5%. However, The therapeutic efficacy was only excellent in 13 patients, good in 3 patients in the control group. the excellent & good rate was 76.2%. Lesion segments were stable and no recurrence was found in all final follow-up cases. Conclusion One-stage posterior debridement together with antibiotics-calcium phosphate grafting and internal fixation is an effective method for the treatment of lumbosacral tuberculosis.

Key words: Lumbosacral tuberculosis, Debridement, Calcium phosphate, Iliac screw, Fixation

胡资兵,曾荣,魏波,魏劲松,孙欣,林颢,陈思圆 . 髂骨螺钉联合磷酸钙骨粉在腰骶椎结核中的应用[J]. 中国临床解剖学杂志, doi: 10.13418/j.issn.1001-165x.2015.03.025.

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