前路手术在胸腰椎结核治疗中的优势

Advantages of anterior approach in treatment of thoracolumbar tuberculosis

目的总结前路一期病灶清除、硬膜前方减压、一期后凸畸形矫正、植骨及内固定重建脊柱稳定治疗胸腰椎结核的临床疗效。方法回顾性分析我院2007年1月~2015年1月通过一期前路手术病灶清除、硬膜前方减压、一期后凸畸形矫正、植骨及内固定重建脊柱稳定治疗的胸腰椎结核32例的临床资料。统计植骨融合时间及手术前后血沉(ESR)、C-反应蛋白(CRP)、后凸畸形角度(Cobb角)和ASIA分级的变化。结果手术时间为(177.3±14 5)min,术中出血量为(492.5±170.1)ml。随访18~72(36.9±12.7)个月,所有患者脊柱结核治愈无复发。植骨融合时间3~8(5.5±1.1)个月。血沉及C-反应蛋白在术后3个月基本恢复正常,末次随访时ASIA分级均恢复正常。脊柱后凸畸形角度由术前(17.6°±6.4°)减小至术后的(2.5°±1.3°),末次随访为(3.8°±1.5°),没有显著的矫正角度的丢失(1.3°±0.6°),其中术后、末次随访较术前明显改善,差异有统计学意义(P<0.05)。在末次随访时,所有患者的植骨融合良好,无内固定松动及断裂。结论前路手术在胸腰椎结核中可以达到一期病灶清除、硬膜前方减压、一期后凸畸形矫正、植骨及内固定并重建脊柱稳定性的目的,临床疗效满意。

Objective To analyze the clinical outcomes of one-stage anterior debridement , dura splitting decompression , one-stage kyphosis correction , bone grafting and internal fixation in the treatment of thoracolumbar tuberculosis .Methods Clinical data of 32 cases with thoracolumbar tuberculosis who underwent above surgeries in our hospital from January 2007 to January 2015 were collected retrospectively.The time of bone graft fusion, and the changes of erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, kyphotic angle （ Cobb angle ） and American Spine Injury Association （ ASIA ） grade before and after treatment were collected and analyzed.Results The average operation time was （177.3 ±14.5） min, and the mean amount of intraoperative blood loss was （492.5 ±170.1）ml.During the postoperative follow-up of （36.9 ±12.7）months （ranging from 18 to 72 months）, no recurrence of thoracolumbar tuberculosis was found in all the patients .The time of bone graft fusion was （5.5 ±1.1）months （3-8 months）.The levels of ESR and CRP were gradually declined to normal levels at 3 months after operation .Their ASIA grades also went back to normal at the last follow-up.The average angle of kyphosis was decreased from （17.6°±6.4°） preoperatively to （2.5°±1.3°） post-operatively, and then to （3.8°±1.5°） at the last follow-up.No significant loss of correction angle （1.3°±0.6°） was observed, but the angle was greatly improved postoperatively and at the last follow-up when compared with that before operation （P〈0.5）.At the last follow-up, all patients got solid bony fusion and had no evidences of internal fixation and fracture .Conclusion Anterior operation is suitable to one-stage anterior debridement , dura splitting decompression , one-stage kyphosis correction , bone grafting and internal fixation and reconstruction of spinal stability for thoracolumbar tuberculosis , with satisfying clinical outcomes .