一期后路病灶清除植骨骶髂固定治疗骶髂关节结核

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1、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

2、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Theoutcomeofautograftandposteriorinstrumentationinthetreatmentofsacroiliac13jointtuberculosisHEQin�1,ZHANGDong�1,WANGHao�1,WANGXiaolin�1

3、,TANGXiaohua�1,WANGQunbo�2.【Abstract】Objective：Toinvestigatetheoutcomeofthepatientswithsacroiliacjointtuberculosiswhounderwentsinglestageradicaldebridementandreconstructionwithboneautograflandposteriorinstrumentationviafixedbetweenosacralandiliumtransperitonealapproach．Methods：Thesacroiliacjointwase

4、xposedadequatelyviaposteriorapproachin12patients，radicaldebridementwasperformed，theniliacboneautograftswereplacedandposteriorfixationwasdonebetweenosacralandiliumtransperitonealapproach．Allthepatientsweretreatedbyantituberculouschemotherapyfor12monthsaftertheoperation，andfollowedupregularlyinonemont

5、h，andevery3monthsuntilayear，thenatintervalsofhalfayear．Theclinicalstatus，ESR，roentgenogramand3D-CTwereconcernedtoestimatetheprogressoftuberculosis．Rradiographswereanalyzedbeforesurgery,immediatelyaftersurgery，andatthefinalfollow-upexaminationtoassess13theresultofsacroiliacjointandmaintenanceofcorrec

6、tion．Results：Therewasnoinjuryofbloodvessel、ureterorcaudaequinaduringthesurgery．Themeanfollow-upperiodwas25months(range18～35months)，noobviouslossofdeformitycorrectionwasobserved、AccordingtoBridwellcriteria，gradeIbonyfusionwasobtainedin11patientsandgradeIIinanotherin9～12months,3patientshasgaitchange,b

7、utwalkingwasnotaffected．Therewasnorecurence，notuberculousperitonitis．andnoincidenceofimpotenceorretrogradeejaculationinanyofthesepatients．Conclusion：Itisanovelchoicetohaveradicaldebridementviaposterio