不同入路内固定手术对老年胸腰椎结核患者脊柱后凸畸形矫正效果的影响

Effect of different operative approaches on correction of kyphosis in elderly patients with thoracolumbar tuberculosis

目的探讨前后不同入路手术对老年胸椎结核患者脊柱后凸畸形矫正效果的影响。方法采用一期病灶清除、自体骨植骨、内固定术治疗老年胸腰椎结核患者68例,包括前入路组37例和后入路组31例,比较两组手术情况及手术前后的血沉(ESR)、C反应蛋白(CRP)指标;中位随访时间28个月,观察Cobb角度、ASIA分级变化及结核复发率。结果两组手术时间、术中出血量、住院时间、术后并发症发生率及术后3个月、末期随访ESR、CRP水平比较,差异无统计学意义(P>0.05);后入路组术后3个月、末次随访的Cobb角显著低于前入路组(P<0.05),术后3个月Cobb角矫正率高于前入路组,末次随访Cobb角丢失率低于前入路组(P<0.05);两组末次随访时ASIA分级、结核复发率差异无统计学意义(P>0.05)。结论前入路或后入路病灶清除、植骨融合、内固定术取得取得良好的效果,但后入路在后凸畸形矫正及维持上更具优势。

Objective To investigate the effect of anterior approach and posterior approachsurgeries on the correction of kyphosis in elderly patients with thoracolumbar tuberculosis. MethodsSixty-eight elderly patients with thoracolumbar tuberculosis were treated with one-stage debridement,autogenous bone grafting and internal fixation, including 37 cases in anterior approach group and 31cases in posterior approach group. The erythrocyte sedimentation rate （ESR）, C reactive protein（CRP）were compared. The median follow-up time was 28 months, the Cobb angle, ASIA grade change andtuberculosis recurrence rate were observed. Results There were no significant differences inoperative time, intraoperative bleeding volume, hospital stay, postoperative complications, ESR andCRP levels between the two groups （P〉0.05）. The Cobb angle in the posterior approach group wassignificantly lower than that in the anterior approach group at 3 months after operation and last follow-up （P〈0.05）. The correction rate of Cobb angle at 3 months after operation in the posterior approachgroup was higher than that of the anterior approach group, and the Cobb angle loss rate at the lastfollow -up was lower than that of the anterior approach group （P 〈0.05）. Conclusion Effects ofanterior approach or posterior approach debridement, bone fusion and internal fixation are good, butposterior approach has more advantages in the correction of kyphosis and maintenance.