传统后外侧切口和腋下微创切口剖胸入路在胸椎结核手术中的应用价值及安全性

Application value and safety of thoracotomy approaches of traditional posterolateral incision versus minimally invasive subaxillary incision in thoracic spine tuberculosis surgery

目的探讨两种不同入路方式在胸椎结核手术中的应用及安全性。方法将2010年6月至2013年6月收治的110例胸椎结核患者随机分为观察组和对照组各55例,两组均行胸椎结核手术治疗,对照组采用传统后外侧切口开胸,观察组采用腋下微创切口剖胸入路。比较两组患者手术一般情况、术后并发症;术后随访1年,比较两组患者临床优良率、融合节段后凸角、胸背疼痛程度以及内固定和植骨融合情况。结果观察组术中出血量、胸痛持续时间、住院时间均显著低于对照组,差异具有统计学意义(P均<0.01);观察组术后暂时性肩胛骨功能障碍发生率显著低于对照组(P<0.05);观察组优良率为93.3%,对照组为86.7%,两组相比差异无统计学意义(P>0.05);术后1周、6个月、1年两组患者融合节段后凸角、胸背疼痛程度相比差异无统计学意义(P均>0.05);两组患者植骨全部达骨性融合,融合率均为100.0%;植骨块无松动、断裂或脱落等情况,内固定情况良好。结论腋下微创切口剖胸入路可以作为胸椎结核外科手术的一种有效手段,且术后并发症发生率更低。

Objective To explore the application and safety of two kinds of operation approach in thoracic spine tubercu- losis surgery. Methods A total of 110 patients with thoracic spine tuberculosis admitted between June 2010 and June 2013 were enrolled in this study. The patients were randomly divided into two groups （n = 55 each） ：observation group and con- trol group. The surgical treatment for thoracic spinal tuberculosis were performed in two groups. In control group, the thora- cotomy via traditional posterolateral incision approach was performed;in observation group, the thoracotomy via minimally invasive subaxillary incision approach was performed. The general information of surgery, postoperative complications in two groups were compared. All patients were followed up for one year. The clinical excellent plus good rate, kyphosis of fusion segments, chest and back pain degree, the situations of internal fixation and fusion of bone grafting in two groups were com- pared. Results The volume of intraoperative bleeding, the continuous time of chest pain and the hospitalization stay were all significantly lower in observation group than those in the control group （ all P 〈 0.01 ）. The incidence of temporary scap- ular dysfunction was significantly lower in observation group than that in the control group （ P 〈 0.05 ）. There was no signif- icant difference in excellent plus good rate between observation group and control group （93.3 % vs 86.7 %, P 〉 0.05 ）. At 1-week ,6-month, 1-year after operation,there were no significant differences in the kyphosis of fusion segments and chest and back pain degree between two groups （all P 〉 0.05 ）. The bony fusion was achieved in all patients of two groups, and the bone grafting fusion rate was 100%. No loosening, no breaks and no dislocation of bone grafts were found, and the internal fixation was in good condition. Conclusion Minimally invasive subaxillary thoracotomy approach can be used as an effective method of thoracic spine tuberculosis operation and has the advantage of lower incidence of postoperative complications.