微创手术治疗腰椎和腰骶椎结核的临床研究

摘要

目的 探讨CT引导下微创手术治疗腰椎和腰骶椎结核的价值和意义.方法 2002年1月至2006年8月收治保守治疗无效的腰椎和腰骶椎结核61例.开放手术4例;微创手术57例,获得1年以上随访者49例.男28例,女21例;年龄12～78岁,平均(47±18)岁;腰椎40例,腰骶椎9例.累及椎体数目:L1 8椎.L2 26椎,L3 19椎,L4 19椎,L5 21椎,S1 10椎.单椎体结核3例,双椎体39例,三椎体6例,四椎体1例为跳跃结核.术前合并不全截瘫3例,Frankel分级均为D级.CT引导下,在病灶和脓肿内置管,局部化疗灌注冲洗.测量治疗前及终末随访时后凸角,并应用Oswestry功能障碍指数对其功能恢复情况进行评价.结果 随访最短1年,最长5年8个月,平均35个月.所有患者均达临床愈合.随访期内未见复发病例.Oswestry功能障碍指数术前为(70.12±20.24)分,终末随访时为(12.72±8.62)分,两者相比差异有统计学意义(t=21.42,P<0.001).治疗前后凸角平均为16.47°±8.74°,终末随访时平均为13.35°±8.02°,两者差异有统计学意义(t=5.785,P<0.001).结论 保守治疗无效而没有神经受累表现的腰椎和腰骶椎结核通过微创手术能够获得较好的治疗效果.%ObJective To evaluate the outcomes of CT-guided percutaneous puncture and local chemotherapy for lumbar or lumbosaeral spinal tuberculosis. Methods From January 2002 to Auguest 2006, 61 patients with lumbar or iumbosaeral spinal tuberculosis who were failed with conservative treatment were treated by minimal invasion surgery, and 49 patients of them were followed up more than 1 year. There were 21 females and 28 males. The mean age of the patients was 47±18 years (range from 12 to 78 years). There were 40 eases with lumbar spine tuberculosis, and 9 cases with lumbosacral spine tuberculosis. From L1 to S1, the involved numbers were 8,26,19, 19,21 and 10, respectively. The spinal tuberculosis was in- volved in single vertebral for 3 cases, double vertebrals for 39 cases, three vertebrals for 6 cases and four vertebrals for ordy one case. Four patients were recurrence after simple debridement of spinal tuberculosis. Three patients with grade E incomplete paralysis preoperatively according to Frankel scale. By CT-guided percutaneous puncture and local chemotherapy, the outcomes were retrospective analysed by preoperative and postoperative kyphotic angle and Oswestry scores. Results The patients were followed up one year to 5 years and 8 months (average 35 months). All cases were recovered, and there had no recurrence. Preopera- tively, the kyphotic angle was 16.47±8.74 degree, and decreased to 13.35±8.02 degree at the final follow-up (t=5.785,P<0.001 ). The average Oswestry score was improved from 70.12±22.24 preoperatively to 12.72± 8.62 at the final follow-up. There were significent differences (t=21.42, P< 0.001).Conclusion The majority of lumbar and lumbosacral spine tuberculosis can get better result with minimal invasive surgery. It is worth- ly recommended in the clinical application.