经皮椎间孔入路内镜下病灶清除、植骨联合后路经皮内固定治疗胸、腰椎结核

摘要

Objective To discuss the feasibility,the advantages and disadvantages,the clinical efficacy and the indications of minimally invasive transforaminal endoscopic debridement combined with allograft and posterial percutaneous internal fixation for thoracolumbar spinal tuberculosis.Methods All of 22 patients with thoracolumbar tuberculosis treated in our department from January 2012 to December 2013 were retrospectively reviewed.There are 11 male and female cases separately,with an average age of 54.1 ±10.2 years and with an average disease duration of 5.3 ± 1.9 months.Endoscopic lesion removal and allograft bone grafting combined with posterial percutaneous immobilization were performed on all these cases.The data of these patients were complete,and all patients had been followed up for more than 36 months.The clinical and radiographic results were recorded and analyzed.Results In this group,22 patients were followed-up for 41.9±2.5 months(36-48 months).The spinal kyphosis was not improved 3 months after surgery (t=0.3546,P=0.7029),but the amount of blood loss (30.5±7.9 ml) was less in the operation,the amount of postoperative analgesics(0.3±0.1 g) was low and the bed time(1.5±0.3 days) was short.No recurrence and no internal fixation failure was found after long term follow-up.Good clinical outcomes were achieved with the fusion rate reached above grade 2 in all patients(95.5％) except one.The neuralgia was relieved,and the spinal cord injury was recovered to ASIA E.The VAS score and SF-36 score which were recorded 1 month and 3 months after operative were all improved significantly compared with those before operation,and patients' life quality in the early period after operation was excellent.The incidence of complications was low(9.0％),and the patients were satisfied with the treatment process.Conclusion It may be a potential way to treat spinal tuberculosis with minimally invasive transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation,which could be a powerful supplement to other therapeutic measures,and is worthy of further research and development.%目的 探讨经皮椎间孔入路内镜下微创病灶清除、异体骨植骨联合后路经皮内固定治疗胸、腰椎结核的可行性和临床疗效,并总结其手术适应证.方法 收集2012年1月至2013年12月期间采用经皮椎间孔入路内镜下病灶清除、异体骨植骨联合后路经皮内固定术治疗的胸腰椎结核患者病历资料,对资料完整并获得36个月以上有效随访的22例患者进行回顾性分析.男、女各11例;平均年龄(54.1±10.2)岁;平均病程(5.3±1.9)个月.均采用经皮椎间孔入路内镜下病灶清除、异体骨植骨联合后路经皮内固定术.记录并分析患者的手术时间、术中失血量、术后止痛药用量、卧床时间、术中透视次数及术后并发症发生情况,疗效评价采用疼痛视觉模拟评分(visual analogue scale,VAS)、健康调查简表(theMOS item short from health survey,SF-36)、美国脊柱损伤协会(American spinal injury association,ASIA)脊髓损伤分级、结核治愈情况、植骨融合情况及临床满意率等指标.结果 22例患者随访时间为36～48个月,平均(41.9±2.5)个月.虽然术后3个月病变节段后凸角度并未改善(t=0.3546,P=0.7029),但术中失血量少[(30.5±7.9)ml],术后止痛药用量低[(0.3±0.1)g],卧床时间短[(1.5±0.3)d].22例患者术后结核病灶均获得治愈且无复发.除1例患者外,其余21例(95.5％)患者植骨均达到2级以上融合.术前存在神经放射痛的患者术后均明显缓解,3例术前D级患者术后均恢复至E级.术后1和3个月随访时VAS评分、SF36各项评分较术前明显好转,术后早期生活质量优秀.随访期间无内固定相关并发症发生,并发症发生率为9.0％,患者对治疗过程及疗效满意.结论 经皮椎间孔入路内镜下微创病灶清理、异体骨植骨联合经皮内固定可能是很有潜力的脊柱结核治疗方法,可作为其他治疗措施的有力补充,值得进一步研究和开展.