胸腰椎脊柱结核的手术治疗方式选择及疗效评价

Selection of surgical treatment methods for thoracolumbar spinal tuberculosis and therapeutic effect evaluation

[目的]比较前路和后路两种病灶清除植骨内固定术对胸腰椎脊柱结核清除结核病灶、脊髓神经减压及重建脊柱稳定性的疗效。[方法]随机抽取2008年10月~2014年2月手术治疗的胸、腰椎脊柱结核69例进行回顾性分析,根据手术方式分为前路手术组（前路组）31例和后路手术组（后路组）38例,比较两组患者住院时间、手术时间、术中出血量、疼痛视觉模拟评分（visual analog scale,VAS）及功能障碍评分（Oswestry disability index,ODI）降低值、满意度的差异。[结果]后路组患者ODI评分术后降低值大于前路组,虽差异无统计学意义,但P值为0.54;后路组患者手术时间、术中出血量及住院时间均少于前路组,均P〈0.05。[结论]前路和后路病灶清除植骨内固定术对胸腰椎脊柱结核均有较好的治疗效果,相比而言前路手术组创伤较大,后路手术具有一定的优势。

[ Objective] To investigate the therapeutic effect of anterior or posterior debridement combined with bone graft internal fixation in removal of tuberculosis lesions, spinal nerve decompression, and reconstruction of spinal stability in the sur- gical treatment of thoracolumbar spinal tuberculosis. [ Methods ] The clinical data of 69 patients with thoracolumbar spinal tu- berculosis who were admitted from October 2008 to February 2014 were analyzed retrospectively. There were 41 male and 29 female patients aged 14 -68 years （mean 38.6 years） . Among these patients, 31 underwent anterior surgery （group A） and 38 underwent posterior surgery （ group B） . The two groups showed no significant differences in age, sex, course of disease, preoperative Visual Analogue Scale （VAS） score, and Oswestry Disability Index （ODI） score （P 〉 0. 05 ） . [ Results ] All the patients finished the surgery successfully, and the postoperative follow-p time was 11 -46 month （mean 26. 1 months） . The two groups showed significant changes in VAS score and ODI score after surgery （ P 〈 0. 05 ） , and after the treatment with these two methods, VAS score was reduced by （3. 2 ± 1.1 ） and （3. 4±1.2）, respectively, and showed no significant difference between group A and group B （ t = 0. 7147, P = 0. 477 3 ） . The ODI score was reduced by （ 10. 3±3.2） and （ 11.8±3.4）, respectively, in group A and group B, and showed no significant difference between the two groups （t = 1. 871 4, P = 0. 065 7） . The patients degree of satisfaction showed no significant difference between group A and group B （71.4% vs 66. 7%, t = 1. 345 1, P = 0. 1334） . The comparison of time of operation, intraoperative blood loss, and length of hospital stay between the two groups showed that the surgery in group A caused greater trauma than that in group B. [ Conclusion] Anterior or posterior debridement combined with bone graft internal fixation are effective in the treatment of lumbar spinal tuberculosis. Anterior surgery may cause great trauma, and posterior surgery has certain advantages.