背景:本研究旨在分析下颈椎结核一期前路病灶清除术中应用髂骨植骨融合内固定的临床疗效。
方法:对2018年6月至2021年6月多个医疗中心收治的48例下宫颈结核患者进行回顾性分析。其中,36例患者的病变涉及两个椎骨,12例患者的病变涉及三个以上椎骨。所有患者术前均给予四联抗结核药物治疗2周以上,然后进行一期前路清创术和自体髂骨植骨融合结合钛板内固定治疗。手术后,抗结核药物持续12-18个月.随访观察患者临床症状改善情况,植骨融合,Cobb角,视觉模拟评分(VAS),红细胞沉降率(ESR),C反应蛋白(CRP),伤口愈合,和神经功能。
结果:随访13~43个月,平均21.46±1.52个月。术后临床症状明显改善。所有患者的植骨完全融合,骨融合时间为3-6个月,平均4.16±0.47个月。在最后一次随访中,Cobb角,VAS,ESR,CRP水平均显著低于术前(P<0.05)。没有病人有松动,脱离,或内固定破裂,没有复发。所有手术切口均一期愈合,无感染或鼻窦形成。术前Frankel神经功能分级为B级7例,13级为C级,18级为D级,10级为E级。在最后一次随访中,8例恢复到D级,40例恢复到E级。
结论:对于下宫颈结核患者,基于口服四联抗结核药物,通过前路清创直接减压,接自体髂骨植骨融合结合内固定可彻底切除结核灶,重建颈椎的稳定性,取得良好的临床疗效。证据等级3级。
BACKGROUND: This study aimed to analyze the clinical efficacy of one-stage anterior debridement of lower cervical tuberculosis using iliac crest bone graft fusion and internal fixation.
METHODS: A retrospective analysis was performed on 48 patients with lower cervical tuberculosis admitted to multiple medical centers from June 2018 to June 2021. Among them, 36 patients had lesions involving two vertebrae and 12 patients had lesions involving more than three vertebrae. All patients were treated with quadruple antituberculosis drugs for more than 2 weeks before the operation, and then treated with one-stage anterior debridement and autogenous iliac bone graft fusion combined with titanium plate internal fixation. After the operation, antituberculosis drugs were continued for 12-18 months. The patients were followed-up to observe the improvement in clinical symptoms, bone graft fusion, Cobb angle, visual analog score (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), wound healing, and neurological function.
RESULTS: The patients were followed-up for 13-43 months, with an average of 21.46 ± 1.52 months. The clinical symptoms significantly improved after the operation. The bone graft was completely fused in all patients, and the bone fusion time was 3-6 months, with an average of 4.16 ± 0.47 months. At the last follow-up, the Cobb angle, VAS, ESR, and CRP level were significantly lower than those before surgery (P < 0.05). None of the patients had loosening, detachment, or rupture of the internal fixation, and no recurrence occurred. All surgical incisions healed in one stage without infection or sinus formation. The preoperative Frankel neurological function classification was grade B in 7 cases, grade C in 13, grade D in 18, and grade E in 10. At the last follow-up, 8 cases recovered to grade D and 40 recovered to grade E.
CONCLUSIONS: For patients with lower cervical tuberculosis, based on oral treatment with quadruple antituberculosis drugs, direct decompression through anterior debridement, followed by autologous iliac bone graft fusion combined with internal fixation can completely remove tuberculosis foci, rebuild the stability of the cervical spine, and obtain good clinical efficacy. Level of evidence Level 3.