经多裂肌间隙与后正中入路一期病灶清除内固定治疗胸腰椎结核的临床疗效对比研究

Comparison of clinical efficacy between multifidus muscle gap and posterior midline approach in one-stage debridement and internal fixation for treating thoracolumbar spinal tuberculosis

目的评价经多裂肌间隙与后正中入路在治疗30例胸腰椎结核的疗效。方法对我院2008年3月～2010年3月的30例诊断为胸腰椎结核的患者均采用I期后路手术治疗与抗结核治疗，14例采用经多裂肌间隙人路（微创组），16例传统正中入路（传统组），采用短节段椎弓根螺钉固定、后路病灶清除、矫正后凸畸形。比较两组患者的手术时间、术中出血量、术后引流量、住院时间、VAS评分、ODI评分、Cobb角及植骨融合情况等。结果微创组与传统组术中出血量分别为230±70mL和550±96mL，两组差别有统计学意义（P〈0．01）。微创组与传统组术后引流量分别为185．4±56．3mL和479．2±117．7mL，两组差别有统计学意义（P〈0．01）。两组患者术前血沉在55±75mm／h，术后随访3-9个月时血沉达到正常水平（〈20mm／h），两组的血沉术后随访无统计学意义。术前测量微创组与传统组Cobb角分别为19．9±5．60和17．6±4．5°，术后分别为8．9±5．40和9．6±5．7°，两组均较术前有明显纠正，有统计学意义（P〈0．01），术后Cobb角纠正两组比较无明显差异（P〉0．05）。微创组术后6周内VAS评分、ODI较传统组缓解快。随访24～36个月后．评分差异分别无统计学意义。且两组的并发症发生率、后凸畸形矫正角度、植骨融合率、神经功能恢复无统计学意义。结论经多裂肌间隙人路治疗胸腰椎结核临床疗效肯定，且术后恢复快。

Objective To evaluate the clinical effect on surgical procedures of trams multifidus muscle gap and posterior midline approach in the treatment of thoraeolumbar tuberculosis. Methods From March 2008 to March 2010,30 patients were diagnosed as spinal tuberculosis and treated with one-stage posterior surgery and anti-TB treatment, including 14 cases of the traMs multifidus muscle gap approach （multifidus muscle gap group）, 16 cases of conventional midline approach （traditional group）. Short-segment pedicle screw fixation and posterior debridement,correction of kyphosis were used. The operative time, blood loss, postoperative drainage, hospital stay time, VAS score, ODI score, Cobb angle and interbody fusion were compared between two groups. Results Blood loss in traMs multifidus muscle gap group and traditional group were in 230±70 mL and 550± 96 mL respectively （P〈0.01）. Postoperative drainage in two groups were in 185±56 mL and 479±118 mL respectively（P〈0.0l ）. Two groups of patients in the preoperative erythroeyte sedimentation rate were in 55-75 mm/h, and in the postoperative follow-up for 3±9 months, the ESR reached to normal level（〈 20 mm/h）. Preoperative measurement of Cobb angle between multifidus musle gap group and the traditional group were 19.9±5.6% and 17.6±5.4% respectively, postoperative Cobb angle were 8.9±5.4%.and 9.6±5.7%（P〈0.01 ）. Cobb angle correction showed no significant difference between two groups（P〉 0.05）. In trans muhifidus musle gap group,VAS scores and ODI score were better than that in traditional group in 6 weeks after operation, but no difference was observed in 24-36 months. And the incidence of complications in both groups, correction of kyphosis angle, fusion rate, recovery of neurological function showed no statistically significance. Conclusion Trans multifidus muscle gap approach has good clinical efficacy and gets rapid postoperative recovery.