微创侧路病灶清除融合内固定治疗腰椎结核
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摘要
目的探讨微创侧方入路病灶清除椎间融合术治疗腰椎结核的疗效。方法回顾性分析2013年1月~2014年6月15例腰椎结核患者的资料,男6例,女9例,年龄25~72岁,平均48.5岁。受累节段均为单间隙2个椎体,发病部位L2/36例,L3/45例,L4/54例。采用微创通道下病灶清除、植骨骨融合内固定治疗。术后应用异烟肼、利福平、乙胺丁醇、吡嗪酰胺抗结核治疗1年。结果随访8~12个月,平均10.3月,末次随访时疼痛视觉模拟评分(2.3±1.4)分,与术前(8.2±1.1)比较有显著性差异(配对t检验,t=25.23,P=0.00)。2例一侧大腿一过性前方麻木。植骨均获融合,融合时间6~12个月,平均9.2月。结论微创侧方入路病灶清除椎间融合术是治疗活动期腰椎结核有效和安全的方法。
Objective To investigate the clinical effects of debridement,bone autograft and internal fixation via minimally invasive lateral approach for lumbar spine tuberculosis. Methods A retrospective analysis was made on the clinical data of 15patients( 6 male cases and 9 female cases) with lumbar spine tuberculosis undergoing debridement,bone autograft and internal fixation via minimally invasive lateral approach from January 2013 to June 2014. The age ranged from 25 to 72 years old( mean,48. 5 years old). The involved vertebral bodies were at L2 /3in 6 patients,at L3 /4in 5 patients,and at L4 /5in 4 patients. All the cases received medication of four antitubercular drugs( HRES) for 1 year after operation. Results All the patients were followed up for 8-12 months postoperatively( mean,10. 3 months). At the last follow-up review,the back pain VAS scores were improved from preoperative( 8. 2 ± 1. 1) points to postoperative( 2. 3 ± 1. 4) points( paired t-test,t = 25. 23,P = 0. 00). Two patients developed isolated,transient proximal lower extremity numbness. All the patients got solid bony union with an average fusion time of 9. 2 months( range,6-12 months). Conclusion Minimally invasive lateral approach debridement and interbody fusion is an effective and safe treatment for thoracic and lumbar spinal tuberculosis.
Objective To investigate the clinical effects of debridement,bone autograft and internal fixation via minimally invasive lateral approach for lumbar spine tuberculosis. Methods A retrospective analysis was made on the clinical data of 15patients( 6 male cases and 9 female cases) with lumbar spine tuberculosis undergoing debridement,bone autograft and internal fixation via minimally invasive lateral approach from January 2013 to June 2014. The age ranged from 25 to 72 years old( mean,48. 5 years old). The involved vertebral bodies were at L2 /3in 6 patients,at L3 /4in 5 patients,and at L4 /5in 4 patients. All the cases received medication of four antitubercular drugs( HRES) for 1 year after operation. Results All the patients were followed up for 8-12 months postoperatively( mean,10. 3 months). At the last follow-up review,the back pain VAS scores were improved from preoperative( 8. 2 ± 1. 1) points to postoperative( 2. 3 ± 1. 4) points( paired t-test,t = 25. 23,P = 0. 00). Two patients developed isolated,transient proximal lower extremity numbness. All the patients got solid bony union with an average fusion time of 9. 2 months( range,6-12 months). Conclusion Minimally invasive lateral approach debridement and interbody fusion is an effective and safe treatment for thoracic and lumbar spinal tuberculosis.
引文
1 施建党,王自立,耿广起,等.单纯应用抗结核药物治疗早期脊柱结核的疗效观察.中国脊柱脊髓杂志,2011,21(10):798-801.
2 施学东,李淳德,米川,等.单纯前路手术治疗脊柱结核.北京大学学报(医学版),2011,43(5):777-780.
3 高书明,李民,陈汉文,等.CT引导经皮微创与传统开放手术脊柱结核疗效比较.现代中西医结合杂志,2013,22(16):1765-1766.
4 武士科,高文山.CT引导经皮穿刺置管局部给药在高龄脊柱结核中的应用.中国脊柱脊髓杂志,2011,21(10):875-876.
5 詹子睿,张西峰.CT导引经皮介入置管灌洗、局部持续化疗治疗脊柱结核的研究.吉林医学,2010,31(18):2807-2809.
6 Barbagallo GM,Albanese V,Raich AL,et al.Lumbar lateral interbody fusion(LLIF):comparative effectiveness and safety versus PLIF/TLIF and predictive factors affecting LLIF outcome.Evid Based Spine Care J,2014,5(1):28-37.
7 Phillips FM,Isaacs RE,Rodgers WB,et al.Adult degenerative scoliosis treated with XLIF.Spine,2013,38(21):1853-1861.
8 Rodgers WB,Cox CS,Gerber EJ.Experience and early results with a minimally invasive technique for anterior column support through extreme lateral interbody fusion(XLIF).US Musculoskeletal Review,2007,1:28-32.
9 Anand N,Rosemann R,Khalsa B,et al.Mid-term to long term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis.Neurosurg Focus,2010,28(3):E6.
10 Tohmeh AG,Rodgers WB,Peterson MD.Dynamically evoked,discrete-threshold electromyography in the extreme lateral interbody fusion approach.J Neurosurg Spine,2011,1:31-37.
11 Uribe JS,Vale FL,Dakwar E.Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery.Spine,2010,35(26 Suppl):S368-S374.
12 Rodgers WB,Gerber EJ,Patterson J.Intraoperative and early postoperative complications in extreme lateral interbody fusion:an analysis of 600 cases.Spine,2011,36(1):26-32.
2 施学东,李淳德,米川,等.单纯前路手术治疗脊柱结核.北京大学学报(医学版),2011,43(5):777-780.
3 高书明,李民,陈汉文,等.CT引导经皮微创与传统开放手术脊柱结核疗效比较.现代中西医结合杂志,2013,22(16):1765-1766.
4 武士科,高文山.CT引导经皮穿刺置管局部给药在高龄脊柱结核中的应用.中国脊柱脊髓杂志,2011,21(10):875-876.
5 詹子睿,张西峰.CT导引经皮介入置管灌洗、局部持续化疗治疗脊柱结核的研究.吉林医学,2010,31(18):2807-2809.
6 Barbagallo GM,Albanese V,Raich AL,et al.Lumbar lateral interbody fusion(LLIF):comparative effectiveness and safety versus PLIF/TLIF and predictive factors affecting LLIF outcome.Evid Based Spine Care J,2014,5(1):28-37.
7 Phillips FM,Isaacs RE,Rodgers WB,et al.Adult degenerative scoliosis treated with XLIF.Spine,2013,38(21):1853-1861.
8 Rodgers WB,Cox CS,Gerber EJ.Experience and early results with a minimally invasive technique for anterior column support through extreme lateral interbody fusion(XLIF).US Musculoskeletal Review,2007,1:28-32.
9 Anand N,Rosemann R,Khalsa B,et al.Mid-term to long term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis.Neurosurg Focus,2010,28(3):E6.
10 Tohmeh AG,Rodgers WB,Peterson MD.Dynamically evoked,discrete-threshold electromyography in the extreme lateral interbody fusion approach.J Neurosurg Spine,2011,1:31-37.
11 Uribe JS,Vale FL,Dakwar E.Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery.Spine,2010,35(26 Suppl):S368-S374.
12 Rodgers WB,Gerber EJ,Patterson J.Intraoperative and early postoperative complications in extreme lateral interbody fusion:an analysis of 600 cases.Spine,2011,36(1):26-32.