胸椎结核后路经椎弓根入路病灶清除椎弓根钉内固定钛网植骨融合术疗效评价

The therapeutic effect evaluation of thoracic spinal tuberculosis posterior transpedicular debridement pedicle screws internal fixation titanium mesh bone graft fusion

目的对比前、后入路结核病灶清除植骨融合术对治疗胸椎结核的效果,探讨后路经椎弓根入路病灶清除椎弓根钉内固定钛网植骨融合术治疗的优势。方法随机抽取接受前路手术与后路病灶清除联合钛网植骨融合椎弓根钉棒系统内固定的胸椎结核患者50例,按照手术适应证选择手术术式,分为前路手术组(前路组)和后路手术组(后路组),每组25例。后路组应用后路经椎弓根入路病灶清除椎弓根钉内固定钛网植骨融合术,前路组应用前路病灶清除植骨融合矫形内固定术。观察两组患者出血量、手术时间,后凸畸形矫正情况,神经功能恢复情况和术后并发症等方面的差异。结果 1后路组手术时间和术中出血量明显低于前路组,Cobb'角平均矫正值明显高于前路组,差异有统计学意义(P<0.05);2两组患者术后神经功能恢复为E明显高于治疗前,差异有统计学意义(P<0.01);但两组患者治疗后相比,差异无统计学意义(P>0.05);3后路组患者术后并发症发生率明显低于前路组,差异有统计学意义(P<0.05)。结论后路经椎弓根入路病灶清除椎弓根钉内固定钛网植骨融合术具有病灶清除彻底,创伤小,畸形矫正、植骨融合满意等优点,是修复胸椎脊柱结核的有效方案,较前路手术有其优势。

Objective To compare the effect of anterior and posterior tuberculosis debridement bone graft fusion for thoracic spinal tuberculosis,and explore the advantages of posterior transpedicular debridement pedicle screws internal fixation titanium mesh bone graft fusion. Methods The clinical data of 50 patients with thoracic spinal tuberculosis performed anterior operation and posterior debridement,internal fixation bone graft fusion were divided into 2 groups according to surgical ways： the anterior path group and the posterior group（ 25 cases in each group）.The posterior group performed posterior transpedicular debridement pedicle screws internal fixation titanium mesh bone graft fusion while the anterior group performed anterior approach combined with debridement,bone grafting and instrumentation. The operation time,the amount of intraoperative hemorrhage,malformation correction,recovery of nerve function and postoperative morbidity of the two group were observed. Results ①the operation time and the amount of intraoperative hemorrhage of the posterior path group was distinctly less than that of the anterior path group. The Cobb＇s angle＇s correction value was evidently higher than that of the anterior group and the difference had statistical significance（ P〈0.05）. ②The patients that recovered to E of postoperation were significantly higher than that of pre-operation（ P〈0.01）. There was no statistically significant difference between two groups（ P〉0.05）. ③Postoperative morbidity of the posterior path group was significantly lower than that of the anterior path group（ P〈0.05）. Conclusion Posterior transpedicular debridement pedicle screws internal fixation titanium mesh bone graft fusion debridement has advantages,such as little injury,orthodontic correction,and bone graft fusion satisfaction. It is effective for curing thoracic spinal tuberculosis and shows more advantages compared to the anterior path method.