一期后路与一期前后路手术治疗胸腰椎结核的效果比较

Comparision of one-stage posterior surgery and one-stage anterior-posterior surgery in treatment of thoracic and lumbar tuberculosis

目的比较一期后路与一期前后路联合病灶清除植骨融合内固定术治疗胸腰椎结核的效果。方法 回顾性分析新乡医学院第一附属医院骨科2012年12月-2014年12月收治的71例胸腰椎结核患者,其中后路手术组（A组）20例,行一期后路病灶清除、植骨融合、内固定术;前后路联合手术组（B组）51例,行一期后路经椎弓根固定联合前路病灶清除植骨融合术。比较两组患者的手术时间、术中出血量、住院时间及手术前后的ASIA分级、VAS评分、Cobb角、血沉（ESR）变化、C反应蛋白（CRP）变化、植骨融合情况。结果 随访6-24个月,平均（18±2.4）个月;A组患者在手术时间、术中出血量、住院时间方面较B组明显减少（P〈0.05）,但B组ASIA神经功能评分优于A组（P〈0.05）;两组手术前后的VAS评分、Cobb角、ESR值、CRP变化值差异无统计学意义（P〉0.05）;末次随访时,均无结核复发,内固定失效等相关并发症,均获得骨性融合。结论 两种手术方式的优势和局限应根据病灶位置和结核严重程度进行充分评估,具体病例具体分析,选择合适的术式,以提高手术效果、降低手术风险。

Objective To compare clinical effect of one-stage posterior and one-stage combined anterior-posterior debridement, bone graft and instrumentation for thoracolumbar tuberculosis. Methods From December 2012 to December 2014, in Department of Orthopeadics, the First Affiliated Hospital of Xinxiang Medical University, the clinical data of 71 patients with spinal tuberculosis were reviewed retrospectively, 20 cases in posterior surgery group （group A） were treated with one-stage posterior debridement, bone graft and instrumentation, 51 cases in combined anterior-posterior group （group B） were operated with the posterior pedicle screw fixation and anterior debridement, bone graft and instrumenta- tion. The patient＇s operation time, blood loss, hospital stay and ASIA neurological function before and after surgery, VAS score, Cobb angle, ESR change, C reactive protein （CRP）, bone graft fusion in two groups were compare. Results After 6-24 months followed-up, average was （18±2.4） months, the aspects of operative time, blood loss, hospitalization of pa- tients in group reduced significantly than group B （P 〈 0.05）, but ASIA neurological function in group B was better than group A （P 〈 0.05）; the changes of VAS score, Cobb angle and the ESR and CRP level in two groups were compared, the differences were not statistically significant （P 〉 0.05）; at the last follow-up, no tuberculosis recurrence, no internal fixation failure and related complications happend, all cases had evidence of solid bony fusion. Conclusion The advan- tages and limitations of two surgical methods should be based on lesion location and severity of tuberculosis to make afull assessment, it should analyze specifically for specific cases and choose appropriate surgical method to improve the surgical effect and reduce the risk.