病灶清除植骨内固定治疗胸腰椎结核的术式选择与评价

Selection and Evaluation of Surgical Treatment for Thoracic and Lumbar Spinal Tuberculosis

目的:分析胸椎和腰骶椎结核与其对应的三种手术入路,评价脊柱结核三种手术入路的优缺点,以确定不同部位脊柱结核手术入路选择。方法:纳入本院2011年1月至2015年1月共60例行病灶清除植骨融合内固定术的脊柱结核患者,将患者手术时间、出血量、Cobb角和椎体高度重建作为手术评价的相关指标。结果:前后联合入路组的手术时间、出血量和椎体高度重建明显高于前入路组和后入路组,差异有统计学意义(P<0.05);在前入路组与后入路组比较中其以上指标差异无统计学意义(P>0.05)。结论:前路手术适合于椎体前方破坏严重,并伴有前方脓肿的患者;后路手术适合于椎体后方严重破坏,并形成明显后凸畸形及有后方窦道的患者;前后联合入路适合于椎体严重破坏超过3个以上,且前方伴有巨大脓肿,椎体后方后凸畸形明显的患者,但是手术风险和患者负担会加重。

Objective：To evaluate the advantages and disadvantages of three surgical approaches for the treatment of thoracic and lumbar spinal tuberculosis,and to evaluate the surgical approach to determine the surgical approach for different sites of spinal tuberculosis.Methods：From January 2011 to January 2015,60 cases of spinal tuberculosis in our hospital underwent debridement and fusion with internal fixation were enrolled,and the operative time,blood loss,Cobb angle and the height of vertebral body were used as the evaluation indexes.Results：In the comparison of different types of spinal surgery,the operation time,bleeding volume and vertebral height reconstruction in combined anterior and posterior approach group were significantly higher than those in the anterior group and the posterior group（P〈0.05）.There was no significant difference between the anterior approach group and the posterior approach group（P〈0.05）.Conclusion：Anterior approach is suitable for patients with severe anterior vertebral destruction accompanied by anterior abscess.Posterior surgery is suitable for patients with serious posterior damage accompanied by the formation of vertebral kyphosis and posterior sinus.The anterior and posterior combined approach is suitable for patients with more than 3vertebrae destruction accompanied by anterior huge abscess and vertebral kyphosis,but the risk of surgery and patient＇s economic burden will be increased.