一期后路病灶清除植骨骶髂固定治疗骶髂关节结核.docVIP

一期后路病灶清除植骨骶髂固定治疗骶髂关节结核【中图分类号】R529 【文献标识码】A 【文章编号】1672－3783(2011)10－0028－01 【摘要】目的：探讨后路一期病灶清除、自体髂骨移植、骶髂固定治疗骶髂关节结核的效果。方法：对12例骶髂关节结核患者采用一期后路显露骶髂关节，彻底清除病灶后用自体髂骨植于骶髂关节，后方COROLADOⅡ或多轴向椎弓根螺钉固定；术后常规支持和抗结核治疗，并定期(术后l、3、6、9、l2个月，以后每6-12月一次)随访，观察血沉变化，摄x线平片、CT三维重建评估结核活动、骨块融合情况。结果：术中无大血管、神经、硬脊膜损伤，随访l8～35个月，平均25个月，结核病变无复发，无窦道形成、大小便功能障碍等并发症发生，根据BridweⅡ标准，11例患者获I级骨性愈合，1例为Ⅱ级骨性愈合，愈合时间9～12个月，但3例有步态改变。结论：经后路暴露骶髂关节结核病灶充分、安全，病灶清除后行自体髂骨块骶髂植骨、后方骶髂固定可有效重建骶髂关节的稳定性，愈合率高。 【关键词】结核；骶髂关节；后路；骶髂固定 The outcome of autograft and posterior instrumentation in the treatment of sacroiliac joint tuberculosis HE Qin?1,ZHANG Dong?1,WANG Hao?1,WANG Xiaolin?1,TANG Xiaohua?1,WANG Qunbo?2. 【Abstract】Objective：To investigate the outcome of the patients with sacroiliac joint tuberculosis who underwent single stage radical debridement and reconstruction with bone autografl and posterior instrumentation via fixed between osacral and ilium transperitoneal approach．Methods：The sacroiliac joint was exposed adequately via posterior approach in 12 patients，radical debridement was performed，then iliac bone autografts were placed and posterior fixation was done between osacral and ilium transperitoneal approach ．All the patients were treated by antituberculous chemotherapy for 12 months after the operation，and followed up regularly in one month，and every 3 months until a year，then at intervals of half a year．The clinical status，ESR，roentgenogram and 3D-CT were concerned to estimate the progress of tuberculosis．Rradiographs were analyzed before surgery,immediately after surgery ，and at the final follow-up examination to assess the result of sacroiliac joint and maintenance of correction．Results：There was no injury of blood vessel、ureter or cauda equina during the surgery．The mean follow-up period was 25 months(range 18～35 months)，no obvious loss of deformity correction was observed、According to Bridwell criteria，grade I bony fusion was obtained in 11 patients and grade II in another in 9～12 months, 3 patients