一期后路病灶清除植骨融合内固定治疗胸腰椎结核的临床疗效

Clinical efficacy of one-stage posterior debridement,bone graft and instrumentation intreatment of thoracolumbar tuberculosis

目的探讨一期后路病灶清除植骨融合内固定治疗胸腰椎结核的临床疗效及安全性,为临床治疗提供依据。方法回顾性分析医院近3年收治的59例胸腰椎结核患者,依据手术方式不同分为后路手术组31例和联合组(前后路联合)28例,分析两组患者术中和术后恢复的相关指标。结果后路治疗组患者治疗后的Cobb角为(14.8±9.8)°,明显低于治疗前的(32.3±10.7)°,其治疗后的血沉为(20.6±6.9)mm/l,明显低于治疗前的(41.3±7.8)mm/l;联合组治疗后的Cobb角为(15.2±10.6)°,明显低于治疗前的(33.1±11.2)°,其治疗后的血沉为(20.2±7.4)mm/h,明显低于治疗前的(40.9±8.9)mm/h,差异均有统计学意义(P<0.05);术后两组在Cobb角、ASIA分级及血沉变化比较,差异无统计学意义,后路治疗组手术时间、术中出血量、住院时间均明显少于联合组,差异有统计学意义(P<0.05)。结论采取一期后路病灶清除、植骨融合内固定治疗和前后路联合治疗胸腰椎结核均取得明显疗效,但后路手术治疗手术时间短、术中出血少,术后恢复快住院时间短。

OBJECTIVE To investigate the clinical efficacy and safety of a posterior debridement bone graft and instrumentation for the treatment of thoracolumbar spinal tuberculosis so as to provide basis for the clinical treatment. METHODS Totally 59 patients with thoracolumbar tuberculosis were divided into two groups depending on the surgical procedure, the posterior surgery group （31 cases） and the joint surgery group （28 cases）. The operation time, intraoperative blood toss, ESR, ASIA grade and Cobb＇ s angle before and after surgery between each group were reviewed and compared respectively. RESULTS The average Cobb＇s angle in posterior surgery group decreased from （32.3±10.7）° preoperatively to （14.8＋ 9.8）° postoperatively（P〈0.05） and that in joint surgery group decreased from（33.1＋ 11.2）° preoperatively to （ 15.2 ± 10.6）° postoperatively （P〈 0.05）. The value of ESR in posterior surgery group decreased from （41.3 ± 7.8）mm/h preoperatively to（20.6 ± 6.9）mm/h postoperatively（P〈0.05） and that in joint surgery group decreased from （40. 9 ztz 8. 9）mm/h preoperatively to （20.2±7.4）mm/h postoperatively （P〈0.05）. No significant difference was noted with respect to Cobb angle, ASIA grade, ESR between two groups postoperatively. However, the operation duration, intraoperative blood loss, length of hospital stay of the posterior surgery group were significantly lower than those in the joint surgery group（P 〈 0. 05）. CONCLUSION Either one-stage posterior debridement, bone graft and instrumentation or combined anterior and posterior surgery can ensure good clinical outcome for thoracolumbar tuberculosis, however, the posterior approach has the advantages of less operation time, less blood loss, and shortened hospitalization.