Objective: To evaluate the safety and effectiveness of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis.
Methods: Between August 2011 and October 2014, 13 patients with lumbosacral tuberculosis were treated by one-stage posterior reserved posterior ligament complex, lesion debridement, bone graft fusion, and internal fixation via unilateral musculussacrospinalis iliac flap approach. There were 8 males and 5 females, aged from 22 to 57 years, with an average age of 35 years. The disease duration ranged from 2 to 19 months, with an average of 6.7 months. According to the American Spinal Injury Association (ASIA) classification criteria, the patients were graded as grade B in 2 cases, grade C in 4 cases, grade D in 5 cases, and grade E in 2 cases before operation. The preoperative Oswestry disability index (ODI) was 36.4±5.7; the preoperative lumbosacral angle was (20.7±0.7)°; the preoperative erythrocyte sedimentation rate (ESR) was (63.4±8.4) mm/1 h; and the preoperative C-reactive protein (CRP) was (38.8±5.2) mmol/L. The operation time and intraoperative blood loss were recorded. The ODI, ASIA grade, lumbosacral angle, and ESR were recorded at last follow-up. Bridwell criterion was used to judge the interbody fusion.
Results: The operation time was 150-240 minutes (mean, 190 minutes), and the intraoperative blood loss was 420-850 mL (mean, 610 mL). No major blood vessel, dural sac, nerve root, and lumbosacral plexus injuries occurred during the operation. Delayed wound healing occurred in 3 cases, and primary wound healing achieved in the other patients. No wound infection or sinus formation was found. All 13 patients were followed up 1.5-6.1 years (mean, 2.8 years). During the follow-up period, there was no tubercular symptom, cerebrospinal fluid leakage, loosening and rupture of internal fixator; and no complications such as retrograde ejaculation and erectile dysfunction occurred in 8 male patients. Solid spinal fusion obtained in all patients with the mean fusion time of 6.4 months (range, 4.2-9.9 months); and all iliac osteotomies healed. At last follow-up, the ODI was 7.2±3.5, the lumbosacral angle was (31.2±0.5)°, and ESR was (9.8±2.5) mm/1 h, all of which improved significantly when compared with pre-operative ones ( P<0.05). The patients were classified as grade D in 2 cases and grade E in 11 cases, which improved significantly when compared with preoperative ones ( Z=-3.168, P=0.002).
Conclusion: One-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis is effective and safe.
目的: 探讨一期后路经单侧骶棘肌髂骨瓣入路手术治疗腰骶椎结核的安全性和疗效。.
方法: 2011 年 8 月—2014 年 10 月，收治 13 例腰骶椎结核患者。采用一期后路保留后方韧带复合体，经单侧骶棘肌髂骨瓣入路行病灶清除、植骨融合、内固定治疗。其中男 8 例，女 5 例；年龄 22～57 岁，平均 35 岁。病程 2～19 个月，平均 6.7 个月。术前美国脊髓损伤协会（ASIA）分级为 B 级 2 例、C 级 4 例、D 级 5 例、E 级 2 例；Oswestry 功能障碍指数（ODI）为（36.4±5.7）分；腰骶角为（20.7±0.7）°；红细胞沉降率（erythrocyte sedimentation rate，ESR）为（63.4±8.4）mm/1 h，C 反应蛋白为（38.8±5.2）mmol/L。记录手术时间和术中出血量；末次随访时 ODI、ASIA 分级、腰骶角及 ESR；采用 Bridwell 标准判断椎间植骨融合情况。.
结果: 手术时间 150～240 min，平均 190 min；术中出血量 420～850 mL，平均 610 mL。术中未出现大血管、硬膜囊、神经根及腰骶丛损伤。3 例切口延迟愈合，其余患者切口均 Ⅰ 期愈合；未见切口感染及窦道形成。13 例患者均获随访，随访时间 1.5～6.1 年，平均 2.8 年。随访期间无结核中毒症状，无脑脊液漏、内固定物松动断裂；8 例男性患者均未出现逆行射精、勃起障碍等并发症。患者椎间植骨均融合，融合时间 4.2～9.9 个月，平均 6.4 个月；髂骨瓣均骨性愈合。末次随访时，ODI 为（7.2±3.5）分，腰骶角为（31.2±0.5）°，ESR 为（9.8±2.5）mm/1 h，均较术前显著改善（ P<0.05）；ASIA 分级为 D 级 2 例、E 级 11 例，较术前显著改善（ Z=–3.168， P=0.002）。.
结论: 一期后路经单侧骶棘肌髂骨瓣入路手术治疗腰骶椎结核安全、有效。.
Keywords: Lumbosacral tuberculosis; musculussacrospinalis iliac flap; posterior approach surgery.