单纯经后路病灶清除椎体间植骨术治疗脊柱结核的大样本临床研究

A large-scale study on surgical treatment of spinal tuberculosis via a posterior approach only

[目的]通过大样本的临床研究探讨应用单纯经后路病灶清除椎体间植骨术治疗脊柱结核的可行性、安全性及确切临床疗效。[方法]回顾分析2003年1月~2015年6月,本院采用手术治疗的单节段脊柱结核共1 054例,男542例,女512例,平均年龄(39.23±6.81)岁(3~84岁)。临床表现主要有胸腰背痛、脊柱后凸畸形、肋间神经痛、截瘫等。其中单纯经后路结核病灶清除、神经减压,由后向前椎体间自体骨或同种异体骨支撑植骨术725例(后路组);采用单纯前路病灶清除、植骨融合钉棒/板内固定术329例(前路组)。[结果]与前路比较,单纯经后路手术时间更短,出血量更少,两组间比较差异有统计学意义(P<0.05)。术后随访18~108个月,平均(62.64±12.37)个月,两组间随访时间、瘫痪恢复效果、植骨融合时间差异无统计学意义(P>0.05);两组间后凸畸形均有不同程度改善,单纯经后路病灶清除椎体间植骨术优于单纯前路术式,差异有统计学意义(P<0.05)。并发症发生率,尤其是严重并发症发生率,单纯经后路病灶清除椎体间植骨术发生率低于单纯前路组。[结论]大样本临床研究表明,对于病灶较局限的单节段脊柱结核,采用单纯经后路手术可取得满意的临床治疗效果,且较单纯前路手术更加安全可行,畸形矫正的效果更好。

[Objective] To evaluate the clinical outcomes of surgical treatment for spinal tuberculosis by debridement and interbody fusion via a posterior approach only by comparison of those via an anterior approach merely. [Methods] A retrospec- tive analysis was conducted on data of 1 054 patients with spinal tuberculosis who received surgical treatment in our hospital from January 2003 to June 2015, including 542 males and 512 females with an average age of （39.23±6.81） years ranged from 3 to 84 years. The main clinical manifestation contained thoracolumbar aches, kyphosis, intercostal neuralgia and paraplegia. Of them, 725 patients underwent debridement, decompression, interbody bone grafting with autologous bone or allograft and pedi- cle screw-rod fixation via a single posterior incision （the posterior group）, while the remaining 329 patients received debride- ment, bone grafting and internal fixation with screw-rod or plate system via an anterior approach only （the anterior group）. [Re- suits] The posterior group had considerable shorter operation time, and less blood loss than the anterior group, with statistical differences between the two groups （P〈0.05）. All the patients were followed up for 18 to 108 months with an average of （62.64±12.37） months. There were no significant differences in extent of neurologic function recovery and time of spinal fusion betweenthem （P〉0.05）. Although kyphosis was significantly correct- ed after operation in both group, the posterior group was sta- tistically superior to the anterior group in deformity correc- tion （P〈0.05）. In addition, the posterior group got statistical- ly lower complication rate than the anterior group, especially in severe complications （P〈O.05）. [Conclusion] This large- scale study reveals that surgical treatment via a single poste- rior approach does achieve satisfactory clinical results for the relatively localized spinal tuberculosis, with advantage of higher security and feasihility, more effective deformity correction over the anterior approach only.