不同入路方法治疗脊柱结核疗效观察

Clinical study on the effect of different approaches for treatment of patients with spinal tuberculosis

目的探讨不同入路一期病灶清除植骨内固定术治疗脊柱结核的疗效观察。方法回顾性分析自2010年1月至2011年12月收治的行手术治疗脊柱结核患者42例,患者均在术前进行3～6周的正规抗结核药物治疗后,采用一期病灶清除、椎间植骨及内固定手术治疗,术后继续抗结核药物治疗9～l2个月。按照入路方法不同分为前入路组和后入路组,术后随访1年,对两组患者进行影像学评价和功能评价,并比较不同入路方法对Cobb角的变化情况。结果术后随访1年,42例脊柱结核按照不同入路方法对Cobb角的平均值进行比较,差异有显著性(P<0.05);后入路组影像学评分优良率(优+良)为95.65%,前入路组优良率为63.16%;后入路组功能评分优良率(优+良)为91.30%,前入路组功能评分优良率为57.89%。两组优良率比较,差异均有统计学意义(P<0.05)。结论在有效抗痨治疗的前提,采用后入路一期病灶清除植骨内固定术治疗脊柱结核有较好的疗效。

Objective To explore curative effect of one-stage radical debridement,interbody fusion and internal fixation in treatment of spinal tuberculosis.Methods The clinical data of 42 patients with spinal tuberculosis during January 2010 to December 2011 were retrospective analyzed,all patients were treated by 3 ～ 6 weeks of formal anti-tuberculosis drug therapy before operation,and they had performed one-stage radical debridement,interbody fusion and internal fixation,and anti-tuberculosis treatment had been continued for 9 to l2 months after surgical treatment.In the follow-up period of 1 year,they were divided into anterior and posterior approach groups according to different approaches.Imaging assessment and functional assessment of patients in these two groups were compared,and change in Cobb Angle was compared between these 2 groups.Results After postoperative follow-up for 1 year,the average value of Cobb angle in 42 cases of spinal tuberculosis had been evaluated and compared according to different approaches,and their difference was statistically significant（P 0.05）.The imaging scores in posterior approache group with optimal plus good were 95.65%,and the fine rate of anterior approach group was 63.16%;the functional scores in posterior approach group with optimal plus good were 91.30%,and the group function scores of anterior approach group were 57.89%.The excellent rates of two groups were compared,and the difference was statistically significant（P 0.05）.Conclusion Under the precondition of effective chemotherapy for tuberculosis,one-stage radical debridement,interbody fusion and internal fixation with posterior approach is effective.