一期后路病灶清除钛笼置入植骨融合椎弓根系统内固定术治疗胸椎结核的临床研究

Clinical effects of posterior debridement,titanium cage implantation combined with bone graft fusion and pedicle screw fixation on patients with thoracic tuberculosis at first stage

目的分析一期后路病灶清除钛笼置入植骨融合椎弓根内固定方法的临床疗效。方法随机选取2015年2月至2018年2月胸椎结核患者48例,对其临床资料进行回顾性分析。根据调查对象的人口学资料和基本病情进行匹配,分别接受方案1、方案2、方案3、方案4治疗,每个治疗方案胸椎结核患者均为12例。术后6个月随访,通过监测若干临床指标评估胸椎结核患者的临床实际疗效。结果术后6个月随访,四种方案治疗后症状缓解(χ~2=21.83,P=0.00)和神经功能恢复(χ~2=19.60,P=0.02)显著。造成该疗效整体差异显著的最主要原因在于,一期后路病灶清除钛笼置入植骨融合椎弓根内固定方案和其余3个方案比较,差异均有统计学意义(P<0.05)。结论一期后路病灶清除钛笼置入植骨融合椎弓根内固定方法相比其他手术方案,可减小手术节段活动度,有效恢复原有生物力学特点,明显缓解临床症状,有利于神经功能恢复。

Objective To investigate the clinical effects of posterior debridement,titanium cage implantation combined with bone graft fusion and pedicle screw fixation on patients with thoracic tuberculosis on first stage. Methods Forty-eight patients with thoracic tuberculosis from February 2015 to February 2018 were randomly selected and their clinical data were retrospectively analyzed. According to the demographic data and the basic condition of the subjects,the patients were treated with scheme 1,scheme 2,scheme 3,scheme 4,and each treatment was carried on 12 patients with thoracic tuberculosis. After following up for 6 months after the operation,the clinical efficacy of the patients with thoracic tuberculosis were assessed by monitoring a number of clinical indicators. Results After 6 months of follow-up,the symptom relief symptoms（ χ^2= 21. 83,P = 0. 00） and the neurological function recovery（ χ^2= 19. 60,P = 0. 02） were significantly improved after four treatment schemes. The main reason for the significant difference in the overall effect was that compared with the other 3 schemes,the clinical effects of posterior debridement,titanium cage implantation combined with bone graft fusion and pedicle screw fixation on patients with thoracic tuberculosis on first stage were better,and the differences were significant（ P〈0. 05）. Conclusions Compared with the other schemes,the posterior debridement,titanium cage implantation combined with bone graft fusion and pedicle screw fixation on patients with thoracic tuberculosis on first stage can reduce operative range of motion,effectively restore the original biomechanical characteristics,relieve clinical symptoms,and which is conducive to the recovery of neurological function.