单纯后路病灶清除椎体间植骨融合内固定治疗脊柱结核的适应证及疗效评价

Indication and effect of internal fixation,debridement and interbody fusion to treat spinal tuberculosis via posterior approach only

[目的]通过脊柱结核单纯后路术式与前后路联合术式的对比研究探讨单纯后路一期病灶清除、椎体间植骨融合内固定治疗脊柱结核的适应证及临床疗效。[方法]总结2004年1月～2010年1月采用单纯后路病灶清除、植骨融合钉棒内固定术与前后路联合病灶清除植骨融合术治疗的308例符合该术式适应证的脊柱结核患者的临床资料。比较两种术式的住院时间、住院费用、手术时间、手术费用、术中出血量、后凸畸形矫正率、复发率、并发症发生率、JOA评分、植骨融合情况,采用3/6/9随访方式,即术后3、6、9个月随访,以后每年复查1次。[结果]随访24～48个月,平均(35.14±9.79)个月。两种术式植骨均获得融合,两种术式各有1例窦道形成。按JOA评分标准临床疗效无统计学差异、植骨融合时间无统计学差异。[结论]对于有适应证的脊柱结核,单纯后路术式是一种安全有效、简便快捷的手术方式,在后凸畸形矫正、住院费用、住院时间、手术时间以及术中出血量等方面明显优于前后路联合术式。

[ Objective ] To evaluate its clinically applied value by a comparative study of posterior route surgery and anteri- or - posterior surgery in the treatment of spinal tuberculosis. [ Methods] Three hundred and eight spinal tuberculosis cases were treated surgically , in the department of spinal surgery of Xiangya hospital, between January 2004 to January 2010. The cases were treated by posterior surgery or anterior - posterior surgery. We divide 308 cases into two groups based on surgery. The two groups were followed up postoperatively. The hospital stays, hospitalisation, the operative time and blood loss, Cobb＇ s angle, incidence of relapse, incidence of complication, JOA grade, fusion status of the two groups were rccorded. [ Results ] The pa- tients were evaluated and followed for at least 24 months （ range , 6 to 48 months ） . The average follow up were 35. 14 ±9. 79 months. All patients achieved solid interbody bone union . Each group had only 1 sinus. The Cobb＇ s angle did not change . There was not statistical significance in JOA grade of the two groups. The posterior surgery was better than anterior - posterior surgery in the hospital stays, hospitalisation, the operative time and blood loss and corrective rate of kyphosis. [ Conclusion] The posterior route surgery is better than anterior - posterior surgery in the hospital stays, hospitalisation, the operative time and blood loss and corrective rate of kyphosis, which is indicative to single - segment spinal tuberculosis or skip spinal tuberculosis.