治疗胸腰椎结核三种手术方式及两种内固定的比较研究

The Comparative Study of Three Kinds of Operation Method and Two Kinds of Internal Fixation inTreatment of Thoracic and Lumbar Tuberculosis

目的 比较三种手术方式及前路或后路内固定治疗胸腰椎结核的临床疗效,为临床合理选择手术方式提供参考.方法 回顾性分析我院收治且定期随访的139例胸腰椎结核患者的临床资料,其中34例行一期前路病灶清除植骨融合、内固定术（A组、前路内固定组）;76例行一期前路病灶清除植骨融合、后路内固定术（B组、后路内固定组）;29例行一期后路病灶清除植骨融合、内固定术（C组、后路内固定组）.比较三种手术方式的手术时间、术中出血量、住院天数、手术前后血沉以及两种内固定的后凸畸形矫正情况、植骨融合时间、内固定失败发生率.结果 随访14 ～ 36个月,平均（18.2±8.6）个月,所有患者术后均恢复良好.平均手术时间,A组、C组明显短于B组（P＜0.05）,A组、C组比较差异无统计学意义（P＞0.05）;平均术中出血量,A组明显少于B组、C组（P＜0.05）,B组、C组比较差异无统计学意义（P＞0.05）.三组间平均住院天数、手术前后血沉比较,差异无统计学意义（P＞0.05）.两种内固定植骨融合时间、内固定失败发生率无明显差异（P＞0.05）,后路内固定组后凸畸形矫正及末次随访Cobb角丢失优于前路内固定组（P＜0.05）.结论 不同手术方式治疗胸腰椎结核均可获得较满意的疗效,但在手术时间、术中出血量以及后凸畸形矫正情况上存在差异,临床上应根据具体情况合理选择手术方式.

Objective To compare the effect of three kinds of operation method and two kinds of internal fixation for treatment to thoracic and lumbar,to provide reference for clinical reasonable select operation method.Methods 139 cases of thoracic and lumbar tuberculosis in our hospital and regular follow-up were retrospectively studied.Among them,34 cases received anterior debridement,bone graft fusion and internal fixation at one-stage （group A、anterior internal fixation group） ;76 cases received anterior debridement and bone graft plus posterior instrumentation（group B、posterior internal fixation group） ;29 cases experienced posterior debridement,bone graft fusion and internal fixation at one-stage （group C、posterior internal fixation group）.All cases follow-up of 14 ～ 36 months,averaged（18.2 ± 8.6） months.The operation time,bleeding volume,hospitalization days,ESR（before and after the operation）of three kinds of operation method and correction of the deformity,bone graft fusion time,internal fixation failure rate of two kinds of convex fix were compared.Results All patients recovered well.The average operation time in group A and group C was obviously shorter than the group B （P ＜ 0.05）,there was no significant difference between group A and C （P ＞ 0.05）.The average amount of bleeding during the operation in group A was significantly less than group B and C （P ＜ 0.05）,but group B compared with C,there was no significant difference （P ＞ 0.05）.Comparison of ESR and hospitalization days between the three groups,as well as bone graft fusion time and internal fixation failure rate between two kinds of the convex fix,difference were not statistically significant（P ＞ 0.05）.The kyphosis correction and Cobb angle less of last follow-up in the posterior internal fixati on group better than the anterior group （P ＜ 0.05）.Conclusion All operation methods for the treatment of thoracic and lumbar tuberculosis can obtain the satisfactory clinical effect,but there was difference in operation time,bleeding volume and kyphosis correction.Clinical reasonable operation mode should be chosen according to specific circumstances.