目的：探讨应用前后联合入路，以改良Galveston技术结合强化固定并钛笼植骨融合术翻修治疗重度腰骶椎结核并后凸畸形的临床疗效。方法选取2010年3月—2013年1月于青海大学附属医院行翻修手术治疗腰骶椎结核复发并后凸畸形12例患者为研究对象，比较翻修术前和术后随访时腰骶角、后凸角、疼痛视觉模拟评分（ VAS）、Oswestry功能障碍指数和JOA下腰痛评分。结果随访时间达到1年的患者有6例，植骨完全融合；无一例腰骶椎结核复发或后凸畸形后期加重。患者末次随访时，腰骶角、后凸角、VAS和Oswestry功能障碍指数均小于术前，JOA下腰痛评分高于术前，差异均有统计学意义（ P＜0.05）。结论应用前后联合入路，以改良Galveston技术结合强化固定并钛笼植骨融合术翻修治疗腰骶椎结核复发并后凸畸形可取得较好的临床疗效，可作为严重腰骶椎结核的手术治疗方法。%Objective To investigate the clinical effects of revision arthroplasty in anterior - posterior combined approach and with improved Galveston technique and bone grafting and fusion method with strengthened fixed titanium cage on patients with lumbosacral tuberculosis relapse complicated with kyphosis. Methods We enrolled 12 patients with lumbosacral tuberculosis relapse complicated with kyphosis who received revision arthroplasty in the Affiliated Hospital of Qinghai University from March 2010 to January 2013. The lumbosacral angle,kyphotic deformity angle,VAS grade,Oswestry grade and JOA grade of the subjects were measured prior to surgery and in follow-up after surgery. Results Six patients had complete fusion in the grafting bone,whose follow -up lasted for one year,and no patients had aggravation in lumbosacral tuberculosis relapse or kyphosis. In the final follow-up,patients had smaller(P<0. 05)lumbosacral angle,kyphotic deformity angle,VAS grade and Oswestry grade than those before surgery,while JOA grade of the patients was higher(P <0. 05)than that before surgery. Conclusion Revision arthroplasty in anterior -posterior combined approach and with improved Galveston technique and bone grafting and fusion method with strengthened fixed titanium cage has a well efficacy on the patients with lumbosacral tuberculosis relapse complicated with kyphosis.
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