两种不同入路手术治疗胸腰椎结核的早期临床疗效评价

Evaluation of Early Clinical Efficacy of Two Different Approaches in the Treatment of Thoracolumbar Tuberculosis

目的评价单纯后路与前后联合入路手术治疗胸腰椎结核的早期临床疗效对比。方法回顾分析从2012-02/2016-12作者单位50例胸腰椎结核患者的临床资料,其中单纯后路行结核灶清除、植骨融合及椎弓根螺钉内固定术30例(单纯后路组),前后联合入路清除结核病灶植骨融合术20例(前后路联合组),记录患者术中出血量、手术时间及住院天数;手术前后1个月检测静脉血C反应蛋白(C-reactive protein,CRP)、血沉(erythrocyte sedimentation rate,ESR),行X线检查计算Cobb角;手术前、术后3个月以视觉模拟评分(visual analogue scale,VAS)和美国脊髓损伤神经学分类国际标准(international standard for neurological classification of spinal cord injury in the United States,ASIA)分别评价疼痛及神经功能恢复情况。结果单纯后路组患者术中出血量、手术时间和患者住院天数均小于前后路联合组(P均<0.01);两组患者术后1个月CRP、ESR、Cobb角、术后3个月VAS评分和ASIA神经功能分级均较术前降低(P均<0.01);两组患者术后CRP、ESR、Cobb角、VAS评分、ASIA神经功能分级等均无统计学差异。结论单纯后路与前后联合入路手术治疗胸腰椎结核均可获得较好临床疗效,但单纯后路手术具有手术方式简单、术中出血量更少、手术及住院时间更短等特点。

Objective To evaluate the early clinical outcomes of posterior approach and anterior and posterior combined approach in the treatment of thoracolumbar tuberculosis.Methods The clinical data of 47 patients with thoracolumbar tuberculosis in authors’hospital from February 2012 to December 2016 were analyzed retrospectively.Among them,30 cases were treated with posterior debridement,bone graft fusion and pedicle screw fixation(posterior approach group),and 20 cases were treated with anterior and posterior combined approach for removal of tuberculosis focus and bone graft fusion(anterior and posterior combined approach group).The intraoperative blood loss,operation time and hospitalization days were recorded.One month after operation,venous blood C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were recorded,Cobb angle were measured by X-ray examination,and three months after operation,visual analogue scale(VAS)score and international standard for neurological classification of spinal cord injury in the United States(ASIA)grade were used to evaluate neurological function recovery.Results The intraoperative blood loss,operation time and hospitalization days in posterior approach group were less than those in anterior and posterior combined approach group(P<0.01).The CRP,ESR,Cobb angle,VAS score and ASIA grade of the two groups at 1 month after operation and 3 months after operation were significantly lower than those before operation(all P<0.01),but there was no significant difference in CRP,ESR,Cobb angle,VAS score and ASIA grade after operation between the two groups.Conclusion Posterior approach,anterior and posterior combined approach can both achieve good clinical outcomes in the treatment of thoracolumbar tuberculosis,but posterior approach can be applied to treat thoracolumbar tuberculosis with less bleeding and shorter duration of operation and hospitalization.