3种手术方式在腰椎结核治疗中的疗效对比

Comparison of clinical effect of three surgical methods in the treatment of tuberculosis of lumbar spine

目的探讨3种手术方式在腰椎结核中的应用价值。方法选择我院2010年4月至2013年1月收治的182例腰椎结核患者作为研究对象,按手术方案分为A组、B组和C组。A组患者采用后路术式治疗,B组患者采用前后路联合术式治疗,C组患者采用前路术式治疗,比较3组患者术中出血量、手术时间、住院时间、Cobb角、血沉(ESR)以及并发症发生情况。结果治疗后3组患者Cobb角和ESR较术前均有较大程度改善,与术前比较差异有统计学意义(P<0.05)。但3组间Cobb角和ESR比较差异均无统计学意义(P>0.05)。3组患者Cobb角变化量和ESR变化量比较差异无统计学意义(P>0.05),但手术时间、术中出血量和住院时间比较差异有统计学意义(P<0.05)。组间比较发现A组患者手术时间、术中出血量和住院时间均低于B组和C组,差异有统计学意义(P<0.05)。B组与C组比较差异无统计学意义(P>0.05)。3组患者并发症发生率比较差异无统计学意义(F=0.382,P>0.05)。结论 3种手术方式治疗腰椎结核均能取得良好治疗效果,但后路术式具有术中出血量少、手术时间和住院时间短等特点,可作为腰椎结核治疗的首选术式。

Objective To compare the clinical effect of three surgical methods in the treatment of tuberculosis of lumbar spine. Methods 182 cases of patients with tuberculosis of lumbar spine from Apr 2010 to Feb 2013 in our hospital were chosen as the experimental objects,and were divided into group A,B and C.Patients in group A were treated with posterior procedure,group B with combined anterior and posterior procedure,and group C with anterior procedure.The results of intraoperative bleeding,operation time,hospital stays,Cobb an-gle,erythrocyte sedimentation rate (ESR)and incidence of various complications before and after operation were compared among the three groups.Results The Cobb angle and ESR values of the patients in the three groups all improved greatly after the opration when compared with their preoperative results,and the differences were statistically significant (P<0.05 ).But there was no significant difference among the three groups in the postoperative Cobb angle and ESR (P>0.05 ),so was it in the variation of Cobb angle and ESR (P>0.05 ).There had statistical significance in the intraoperative bleeding,operation time and hospital stays among the three groups (P<0.05 ).The operation time,bleeding volume and hospital stays of patients in group A were lower than that in group B and C,with statistically significant difference (P<0.05).There had no significant difference in the incidence of various complications among the three groups (F=0.382,P>0.05). Conclusion All three surgical methods for spinal tuberculosis can achieve good results,and the posterior procedure has the advantages of less blood loss,shorter operative time and hospital stays,which could be the preferred surgical method for tuberculosis of lumbar spine.