一期前路病灶清除植骨融合内固定与前后路联合治疗多发下胸椎结核的临床疗效比较

Comparison on clinical effect between one-stage anterior debridement bone graft fusion and anter-posterior combination in the treament of multiple-level thoracic spinal tuberculosis

目的比较一期前路病灶清除、植骨融合与后路固定融合联合前路病灶清除植骨融合治疗多发下胸椎结核的临床疗效。方法 2002年3月至2010年3月该院经前路病灶清除植骨融合治疗62例多发下胸椎结核患者,其中前路单钉棒系统内固定32例（A组）、后路钉棒系统内固定30例（B组）;比较两组治愈率、手术时间、出血量、Cobb′s角及脊髓损伤恢复情况。结果所有患者随访24-36个月,平均28个月,所有植骨骨性融合。术后12个月Frankel分级评价,A组脊髓损伤好转率76.92%（10/13）,与B组（9/11）比较差异无统计学意义（χ^2=0.087,P〉0.05）;A组总体治愈率84.38%（27/32）,与B组85.48%（26/30）比较差异无统计学意义（χ^2=0.066,P〉0.05）;术前、术后及末次随访A组Cobb′s角为（28.16±4.16）°、（5.03±3.24）°、（8.81±2.44）°,与B组（26.83±5.41）°、（5.50±3.03）°、（8.06±2.45）°比较差异无统计学意义（t=1.038、t=0.588、t=1.200,均P〉0.05）;A组手术时间为（171.31±12.84）min,与B组（219.23±21.44）min比较差异有统计学意义（t=10.754,P〈0.05）;A组出血量为（341.25±76.10）mL,与B组（440.67±67.16）mL比较差异有统计学意义（t=5.439,P〈0.05）。结论一期前路病灶清除,前或后路内固定治疗多发下胸椎结核均可获得较好的治疗效果,但病例选择非常重要。

Objective To compare the curative effects between one-stage anterior debridement bone graft fusion and posterior fixation fusion combined with anterior debridement bone graft fusion in the treatment of multiple lower thoracic spinal tuberculosis. Methods A total of 62 patients with multiple lower thoracic spinal tuberculosis in our hospital from March 2002 to March 2010 were treated by the anterior debridement bone graft fusion,including 32 cases of anterior internal fixation by one screw-rod system （group A） and 30 cases of posterior internal fixation by two nail-stick systems（group B）. The cure rate, operation time, bleeding volume,the Cobbls angle and recovery situation of spinal cord injury were compared between the two groups. Results All patients were followed up for 24--36 months （average 28 months） and showed successful bone graft fusion. In the Frankel classification evaluation at postoperative 12 months,the improvement rate of spinal cord injury was 76.92%（10/13） in the group A and 81.82% （9/11） in the group B,showing no statistically significant difference （χ^2 =0.087 ,P〉0.05）. The total cure rate was 84.38 % （27/ 32） in the group A and 85.48% （26/30） in the group B,showing no statistically significant difference （χ^2 =0. 066,P〉0.05）. The Cobb＇s angles before operation,immediately after operation and at the last follow-up were （28. 16±4. 16）°, （5.03±3.24）° and （8. 81±2.44）° in the group A and （26. 83±5.41）°,（5.50±3.03）° and（8.06±2.45）° in the group B,showing no statistically significant difference （t = 1. 038, t = 0. 588, t = 1. 200, all P〉0.05）. The operation time was （ 171.31 ±12.84） rain in the group A and （219.23±21.44）rain in the group B,showing statistically Significant difference （t=10. 754,P〈0.05）. The bleeding volume was （341.25±76.10）mL in the group A and （440. 67±67. 16）mL in the group B, showing statistically significant difference （t= 5. 439,P〈0. 05）. Conclusion One-stage anterior debridement,and anterior or posterior internal fixation for treating multiple lower thoracic spinal tuberculosis can obtain the better curative effect,but selecting case is very important.