前路与后路两种术式治疗单节段胸椎结核对比研究

Comparative study of 2 surgical procedures for treatment of single segment thoracic tuberculosis with anterior and posterior approaches

目的探讨前路与后路两种术式治疗单节段胸椎结核的优缺点。方法回顾性分析2006年5月至2013年7月本科收治的56例单节段胸椎结核患者的相关资料,其中男性29例,女性27例;年龄18~76岁,平均38岁。其中前路术式组26例,行一期前路病灶清除、结构性植骨融合内固定术,后路术式组30例,行一期后路病灶清除、结构性植骨融合内固定术,定期随访观察结核治愈、神经功能改善及后凸、侧凸畸形矫正情况。手术时间、出血量、平均住院日、植骨融合时间比较采用独立样本t检验;红细胞沉降率（erythrocyte sedimentaon rate,ESR）、C反应蛋白（C-reactive protein,CRP）、后凸及侧凸畸形比较采用单因素方差分析;术前及末次ASIA等级评分及并发症比较采用非参数检验进行统计分析。结果 56例患者均获得随访,随访时间24~56个月,平均29个月,均获得临床治愈。在后凸及侧凸矫正角度丢失方面,前路术式组〉后路术式组。而在手术时间、术中出血量、平均住院时间、植骨融合时间、神经功能改善、后凸及侧凸畸形矫正度、术后并发症发生率等方面,两组差异无统计学意义（P〉0.05）。结论两种术式治疗单节段胸椎结核均能达到良好的治愈效果。与前路术式相比,后路术式在后凸和侧凸矫正角度的维持上优势明显,安全性好,更具可选择性。

Objective To explore the advantages and disadvantages of 2 kinds of surgical procedures through the comparative study of posterior approach and anterior approach for single segment thoracic tuberculosis. Methods From May 2006 to July 2013,56 single segment thoracic tuberculosis patients were retrospectively analyzed,including 29 males and 27 females at an average age of 38（ 18 ~ 76） years old. The patients in group A underwent one-staged anterior debridement,bone grafting and instrumentation,while the ones in group B underwent single posterior debridement,bone grafting and instrumentation. The patients were followed up to observe the curative effects. The operation time,bleeding amount,hospitalization days,and bone graft fusion time were compared by independent sample t test. The erythrocyte sedimentaon rate（ ESR）,C-reactive protein（ CRP）,and kyphosis and scoliosis deformity were compared by single-factor analysis of variance. The ASIA grade and complications before operation and at the last follow-up were compared with nonparametric test. Results All patients were followed up for an average of 29（ 24 to 56） months. All patients were cured. In the postoperative kyphosis and scolisis angle lost,group A was better than group B.There was no significant differences in the operation time,bleeding amount,hospitalization days,bone graft fusion time, neurological function improvement, kyphosis and scoliosis correction, and postoperative complication incidence between the 2 groups（ P〉 0. 05）. Conclusion Both 2 kinds of surgical procedures have good clinical results in the treatment of thoracic tuberculosis. Compared with the anterior approach,the posterior approach has more advantages in the maintenance of the posterior convex and scoliosis correction.Therefore,it is prior to choose the posterior approach.