三种不同入路手术治疗老年胸腰椎脊柱结核的疗效对比

Clinical effect comparison of three different surgical approaches for thoracolumbar spinal tuberculosis in elderly patients

目的分析3种不同入路手术治疗老年人胸腰椎结核的临床疗效。方法回顾性分析2010年1月—2015年1月收治并获有效随访的48例老年胸腰椎结核患者的临床资料。按手术入路分为3组:A组23例,采用前路手术;B组16例,采用后路手术;C组9例,采用前后联合入路手术。比较3组的手术时间、术中出血量、住院时间、手术前后神经功能美国脊髓损伤协会(ASIA)分级、Cobb角及红细胞沉降率(ESR)等指标的差异。结果所有患者术后均明显好转,C组患者手术时间和住院时间长于A、B组,出血量多于A、B组,差异均有统计学意义(P<0.05);A、B两组手术时间、住院时间和术中出血量比较,差异无统计学意义(P>0.05)。3组间术前Cobb角和术前、末次随访ESR比较差异均无统计学意义(P>0.05)。A组患者术后Cobb角矫正率小于B、C组,术后Cobb角丢失率大于B、C组,差异均有统计学意义(P<0.05);B、C两组术后Cobb角矫正率和术后Cobb角丢失率比较差异无统计学意义(P>0.05)。所有患者术后神经功能明显恢复,均未出现严重并发症。结论 3种不同入路手术治疗老年人胸腰椎结核均能取得良好疗效,只要适应证选择正确,均能有效清除病灶、重建脊柱稳定性、矫正畸形。

Objective To investigate the clinical effect of three different surgical approaches for thoracolumbar spinal tuberculosis in elderly patients.Methods The clinical data of 48 elderly patients with thoracolumbar spinal tuberculosis from January 2010 to January 2015 were retrospectively analyzed.Grouping based on different surgical methods:Group A(n=23)were treated via anterior surgical approach,Group B(n=16)via posterior surgical approach and Group C(n=9)via combined anterior and posterior surgical approach.The data of operation time,intraoperative blood loss,hospital stay time,neurological function based on American Spinal Injury Association(ASIA)classification,Cobb’s angle,and erythrocyte sedimentation rate(ESR)were compared between the 3 groups.Results All patients improved significantly after surgery.The mean operation and hospital stay times were longer in group C than in groups A and B,and intraoperative blood loss was more in group C than that in groups A and B,and the differences were statistically significant(P<0.05);but there was no statistical significance between group A and B(P>0.05).There was no significant difference between the 3 groups in Cobb’s angle preoperatively and pre-operative and final follow-up ESR(P>0.05).The postoperative correction rate of Cobb’s angle in group A was less than that in groups B and C,and the correction loss rate of Cobb’s angle was more in group A than in groups B and C;the differences were statistically significant(P<0.05);but there was no significant difference between groups B and C(P>0.05).The neurological functions were improved significantly and no serious complications were found in all the patients after surgery.Conclusion Three different surgical approaches for thoracolumbar spinal tuberculosis has good therapeutic effect in elderly patients.As long as the surgical indications are correct,it can effectively remove the lesion,reconstruct the stability of the spine,correct the deformity and achieve satisfactory outcome.