三种术式在老年腰椎结核患者中的治疗效果

Therapeutic effect of three surgical methods in elderly patients with lumbar tuberculosis

目的探讨三种术式在老年腰椎结核患者中的治疗效果。方法将240例老年腰椎结核患者随机分为单纯后入路组、单纯前入路组和前后路联合组,各80例。给予各组患者相应手术治疗。比较3组患者创伤指标(手术时间、出血量、术后住院时间、植骨融合时间及术后12个月内并发症发生情况),术前及术后3个月、6个月、12个月的Cobb角、红细胞沉降率(ESR)、视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分,以及术后12个月的矫正率和Cobb角损伤角度。结果前后路联合组的手术时间、出血量、术后住院时间及术后12个月内并发症发生率长于或大于单纯后入路组和单纯前入路组,单纯前入路组的植骨融合时间短于单纯后入路组和前后路联合组(P<0.05)。单纯后入路组术后3个月、6个月、12个月的Cobb角大于单纯前入路组和前后路联合组(P<0.05);术后12个月,单纯后入路组的矫正率高于单纯前入路组和前后路联合组,Cobb角损失角度小于单纯前入路组和前后路联合组(P<0.05)。3组患者术后3个月、6个月、12个月的ESR、VAS评分差异无统计学意义(P>0.05)。单纯后入路组术后3个月、6个月、12个月的ODI评分低于单纯前入路组和前后路联合组(P<0.05)。结论前入路手术、后入路手术及前后路联合手术均可有效减轻老年腰椎结核患者的疼痛感,降低ESR,而后入路手术的椎体畸形矫正效果更优、椎体功能恢复效果更好,前入路手术的植骨融合时间更短。

Objective To investigate the therapeutic effect of three surgical methods in elderly patients with lumbar tuberculosis.Methods A total of 240 elderly patients with lumbar tuberculosis were randomly assigned to simple posterior‐approach group,simple anterior‐approach group,or anterior‐and posterior‐approach combination group,with 80 cases in each group.Corresponding surgical therapy was given to patients in various groups.The trauma indices(operation duration,bleeding volume,postoperative length of hospital stay,bone graft fusion time,and the occurrence states of complications within 12 months after operation),preoperative and 3‐,6‐,and 12‐month postoperative Cobb angle,erythrocyte sedimentation rate(ESR),Visual Analogue Scale(VAS)score,and Oswestry disability index(ODI)score,as well as the corrective rate and loss angle of Cobb angle 12 months after operation were compared between patients of the three groups.Results The anterior‐and posterior‐approach combination group exhibited longer operation duration,greater bleeding volume,longer postoperative length of hospital stay,a greater incidence rate of complications within 12 months after operation as compared with the simple posterior‐approach group and the simple anterior‐approach group,and the simple anterior‐approach group yielded shorter bone graft fusion time as compared with the simple posterior‐approach group and the anterior‐and posterior‐approach combination group(P<0.05).The simple posterior‐approach group interpreted a larger Cobb angle after 3,6,and 12 months of operation as compared with the simple anterior‐approach group and the anterior‐and posterior‐approach combination group(P<0.05).At 12 months after operation,the corrective rate of the simple posterior‐approach group was higher,and loss angle of Cobb angle of the simple posterior‐approach group was smaller than those of the simple anterior‐approach group and the anterior‐and posterior‐approach combination group(P<0.05).There was no statistically significant difference in ESR and VAS score after 3,6,and 12 months of operation between patients of the 3 groups(P>0.05).The ODI score 3,6,and 12 months after operation in the simple posterior‐approach group was lower than that in the simple anterior‐approach group and the anterior‐and posterior‐approach combination group(P<0.05).Conclusion Anterior‐approach surgery,posterior‐approach surgery,and anterior‐and posterior‐approach combination surgery can all effectively relieve pain in elderly patients with lumbar tuberculosis,decrease ESR,whereas posterior‐approach surgery exerts superior effect of vertebral deformity correction,and better recovery effect of vertebral function,while anterior‐approach surgery exerts shorter bone graft fusion time.