不同手术入路治疗胸腰椎结核的疗效分析

Efficacy of different surgical approaches in the treatment of thoracolumbar spinal tuberculosis

目的比较分析脊柱结核患者在规范化抗结核药物治疗前提下，采取前路、后路和前后联合入路手术方法治疗胸腰椎结核的临床疗效。方法统计2010年1月至2016年6月间新疆维吾尔自治区胸科医院所收治的1136例脊柱结核患者中585例胸腰椎结核手术患者，按术式不同分为3个组：前路病灶清除植骨、前路内固定术（A组）155例；后路病灶清除植骨、经椎弓根固定术（B组）158例；前路病灶清除植骨、后路椎弓根内固定术（C组）272例。术后随访3～36个月，通过观察各组患者手术时间、术中出血量、手术前后血红细胞沉降率变化、住院时间、疼痛视觉模拟评分（visual analog scale，VAS）、神经功能（Franked分级改善情况、植骨融合时间及并发症发生率等指标从而评估疗效。结果所有患者均顺利完成手术。3组患者之间比较术后Cobb角[胸椎患者A组（19．3±3．3）°、B组（17．8±5．3）°、C组（15．6±4．4）°，F=0．894、P=0．422；腰椎患者A组（18．4±2．3）°、B组（19．5±2．6）°、C组（16．4±2．8）°，F=2．916、P=0．080]、VAS评分[胸椎A组（3．9±1．3）分、B组（3．8±1．2）分、C组（3．7±1．2）分，F=0．471、P=0．625；腰椎A组（3．7±1．2）分、B组（3．7±1．2）分、C组（3．6±1．2）分，F=0．312、P=0．732]、植骨融合时间[胸椎A组（9．7±2．9）月、B组（9．9±2．6）月、C组（9．5±3．1）月，F=0．417、P=0．659；腰椎A组（9．3±2．9）月、B组（9．7±3．2）月、C组（9．3±3．1）月，F=0．438、P=0．6451差异无统计学意义。3组患者术前Frankel分级B级4例、C级19例、D级110例，至术后末次随访时为C级2例、D级17例，其余114例恢复至E级。结论在规范化抗结核药物治疗的前提下，3种手术方式在胸腰椎结核患者的临床治疗中均可取得良好效果。

Objective To compare and analyze the clinical efficacy of anterior, posterior and anterior and posterior combined surgical operation for the treatment of patients with thoracolumbar spinal tuberculosis. Methods We analyzed retrospectively the clinical data from 585 patients with thoracic and lumbar spinal tuberculosis in 1136 patients with spinal tuberculosis admitted in Chest hospital of the xinjiang uygur autonomous region during January 2010 to June 2016. All patients were divided into three groups including 155 cases with anterior debridement and bone graft, anterior internal fixation as A group, 158 cases with posterior debridement and pedicle fixation as B group and 272 cases with anterior debridement and bone grafting, posterior pedicle fixation as C group according to the different surgical procedure. Some clinical indexes including operation time, intraoperative blood loss, changes of erythrocyte sedimentation rate before and after operation, hospitalization time, visual analogue scale （VAS） for pain, Frankel grading（spinal cord injury severity assessment criteria） improvement, bone graft fusion time and the incidence of complications were observed to assess efficacy for all patients during the follow-up for 3 to 36 months. Results All patients completed the operation successfully. The postoperative Cobb angle was compared among the 3 groups patients with lumbar spinal tuberculosis： （19.3±3.3）° in A group, （17.8±5.3）° in B group and （15.6±4.4）° in C group （F=0. 894,P=0. 422）. The postoperative Cobb angle was compared among the 3 groups patients with thoracic spinal tuberculosis： （18. 4±2.3）° in A group, （19.5±2.6）° in B group and （16.4±2.8）° in C group （F=2. 916,P=0. 080）. The VAS was compared among the 3 groups patients with thoracic spinal tuberculosis： （3.9 ± 1.3） in A group, （3.8 ± 1.2） in B group and （3.7±1.2） in C group （F= 0.471, P= 0. 625）. The bone graft fusion time was compared among the 3 groups patients with thoracic spinal tuberculosis：（9.3±2.9） days in A group, （9.7±3.2） days in B group and （9.3±3.1） days in C group （F=0. 471 ,P=0. 625）. The differences of all above indexes were compared before and after operation without significant statistically. There were Frankel grading B in 4 cases, C in 19 cases and D in 110 cases before operation and C in 2 cases, D in 17 cases and E in 117 cases after operation in three groups. Conclusion Under the premise of standardized antituberculous drugs treatment, three kinds of surgical procedure for treatment of patients with thoracolumbar spinal tuberculosis can achieve good outcome.