后路病灶清除植骨融合加后路内固定术治疗胸腰椎结核的疗效评价

Curative effect of posterior debridement,bone graft fusion and posterior internal fixation in the treatment of thoracolumbar spinal tuberculosis

目的探讨后路病灶清除植骨融合加后路内固定术治疗胸腰椎结核的疗效。方法我院86例胸腰椎结核患者,38例(后路手术组)行后路病灶清除植骨融合及后路内固定手术,48例(前路手术组)行前路病灶清除植骨融合及后路内固定手术。记录两组手术时间、术中出血量及住院天数等指标,评价术后骨融合情况及脊髓功能恢复情况,测定患者Cobb's角、椎体高度、红细胞沉降率(ESR)及C反应蛋白(CRP)值,记录患者术后并发症发生情况。结果后路手术组手术时间、术中出血量、住院天数低于前路手术组(P<0.05);两组X射线检查结果均示植骨融合良好;两组术后神经功能评级、Cobb's角、椎体高度、ESR值、CRP水平较术前均显著改善(P<0.05),组间比较差异无统计学意义(P>0.05);组间并发症发生率比较差异无统计学意义(P>0.05)。结论后路病灶清除植骨融合联合内固定术治疗胸腰椎结核与前后路联合术式治疗均有较好的治疗效果,但后路术式手术时间较短、出血少,住院时间较短。

Objective To explore the curative effect of posterior debridement’bone graft fusion and posterior internal fixation in the treatment of thoracolumbar spinal tuberculosis.Methods Eighty-six patients with thoracolumbar spinal tuberculosis treated in our hospital were selected as study subjects.Of these patients, 38 patients （posterior group） were treated by posterior debridement, bone graft fusion and posterior internal fixation,and 48 patients （anterior group） were treated by anterior debridement,bone graft fusion and posterior internal fixation.The surgical time, intraoperative blood loss and length of hospital stay of the two groups were recorded.Bone fusion and spinal cord function recovery were evaluated.The Cobb angle,vertebral height,erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） were measured before and after surgery.The incidence of postoperative complications was recorded.Results The surgical time, intraoperative blood loss and length of hospital stay in the posterior group were significantly shorter/less than those in the anterior group （ P〈0.05 ） .The both groups were examined by X-ray and the results showed that the bone graft fusions were good.The grade of neurological function,Cobb^ angle,vertebral height,ESR and CRP were significantly improved after surgery （P〈0.05 ） .However, the differences was not significant between the two groups （ P〉0.05 ） .There was also no significant difference in the incidence of complications between the two groups （P〉 0.05 ） . Conclusion The both treatment approaches have a better curative effect in the treatment of thoracolumbar spinal tuberculosis.However,posterior surgery has shorter duration of operation,less blood loss and shorter hospital stay.