一期前后路联合与单纯前路内固定手术治疗腰椎结核的效果对比

Comparison of the Effects of One-stage Combination of the Anterior and Posterior Approaches with Simple Anterior Fixation in the Treatment of Lumbar Tuberculosis

目的比较一期前后路联合与单纯前路内固定手术治疗腰椎结核的临床效果。方法回顾我院2008年9月~2013年9月92例病灶清除植骨内固定术治疗腰椎结核患者的临床资料。其中,A组46例,行一期前后路联合内固定术;B组46例,行一期单纯前路内固定术。所有患者术前均常规予以标准的抗结核药物治疗3周。结果 A组手术时间(315.5±30.4)min、术中出血量(607.0±104.3)ml、术后住院天数(14.0±1.7)d、抗生素使用天数(7.3±1.3)d、术区引流量(230.5±23.4)ml,均高于B组(240.7±35.7)min、(319.3±88.2)ml、(10.0±2.1)d、(4.6±2.1)d、(168.7±25.1)ml(P<0.001),并发症发生率为6.52%vs.2.17%,融合时间为(6.1±1.3)月vs.(5.8±2.3)月,差异无统计学意义(P>0.05);A组患者术后后凸Cobb角矫正率为71.0%±4.3%,高于B组患者的术后矫正率52.0%±3.6%,差异具有统计学意义(P<0.001);术前两组患者后凸角差异无统计学意义(P>0.05);A组患者术后末次随访后凸角小于B组患者,且两组术后末次随访的后凸角均较术前降低,差异均具有统计学意义(P<0.001);随访3.5年后,A组患者的治愈率是93.7%,B组患者是88.6%,差异无统计学意义(P>0.05)。结论一期前后路联合手术治疗腰椎结核可清除病灶,矫正腰椎畸形,且改善后凸畸形矫正率更佳,脊柱稳定性好,故具有更好的矫形效果。

Objective To compare the clinical effects of the one-stage combined anterior and posterior approach with the simple anterior approach in the treatment of lumbar tuberculosis. Methods Retrospective analysis was done in 92 patients with lumbar tuberculosis who underwent bone grafting and internal fixation from September,2008 to September,2013. Among them,there were 46 cases of group A received the combined anterior and posterior approach with internal fixation. And there were 46 cases of group B underwent a simple anterior fixation. All patients were routinely treated with standard anti-TB drugs for 3 weeks before operation.Results In group A,the value of operation time,intraoperative blood loss,postoperative hospital stay,the use days of antibiotic,operation area drainage volume,the incidence of complications,and fusion time was（315. 5 ± 30. 4） ml,（607. 0 ± 104. 3）ml,（14. 0 ± 1. 7）d,（7. 3 ± 1. 3）d,（230. 5 ± 23. 4）ml,6. 52% and（6. 1 ± 1. 3） months respectively,which was higher than that of group B [（240. 7 ± 35. 7） min,（319. 3 ±88. 2） ml,（10. 0 ± 2. 1） d,（4. 6 ± 2. 1） d,（168. 7 ± 25. 1） ml,2. 17% and（5. 8 ± 2. 3） months] except for the complication rate and fusion time（P 0. 001）. The rate of kyphotic correction was 71. 0% ± 4. 3% in group A,which was higher than 52. 0% ± 3. 6% of group B（P 0. 001）. The Cobb angle of group A were less than group B at the last follow-up（P 0. 001）. After 3. 5 years follow-up,the cure rate of group A was93. 7%,which was not different of 88. 6% of group B（P〈0.05）. Conclusion It demonstrates that the one-stage combined anterior and posterior approach provides better local clearace,higher correction rate of malformation and better spinal stability.