后入路小切口清创植骨联合经皮椎弓根钉内固定治疗胸腰椎结核的临床效果

Clinical effect of posterior small-incision lesion removal and bone grafting combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar spinal tuberculosis

目的探讨后入路小切口清创植骨联合经皮椎弓根钉内固定治疗胸腰椎结核的临床效果。方法选取2014年6月～2017年6月我院收治的胸腰椎结核患者作为研究对象,按照患者接受的不同手术方式,分为对照组(31例)与观察组(28例),对照组采用后路清创内固定术治疗,观察组采用后路小切口清创植骨联合经皮椎弓根钉内固定术治疗,两组术后随访时间均为12个月。比较两组的手术时间、术中出血量、术后引流量、术后畸形矫正情况、神经功能恢复情况、伤口愈合率、病灶清除情况。结果观察组的术中出血量、术后引流量均少于对照组,术后伤口Ⅰ期愈合率显著高于对照组,差异均有统计学意义(P<0.05)。两组的手术时间、术后畸形矫正情况、神经功能恢复情况、病灶完全清除率比较,差异均无统计学意义(P>0.05)。结论后入路小切口清创植骨联合经皮椎弓根钉内固定术能减少手术创伤,减少出血量及引流量,减少内固定物与结核病灶创面直接接触,提高伤口愈合率及手术成功率,并能有效清除病灶,促进神经功能恢复及后凸畸形矫正,可为胸腰椎结核手术的治疗提供新尝试。

Objective To investigate the clinical effect of posterior small-incision lesion removal and bone grafting combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar spinal tuberculosis.Methods All of 59 patients with thoracolumbar spinal tuberculosis treated by our hospital from June 2014 to June 2017 were selected as study objects,and they were divided into the control group(n=31)and observation group(n=28)according to the different operation method accepted by patients.The control group was treated by posterior debridement and internal fixation,while the observation group was treated by osterior small-incision lesion removal and bone grafting combined with percutaneous pedicle screw fixation,and the two groups were followed up for 12 months after operation.The operation time,bleeding volume during operation,drainage volume after operation,deformity correction,nerve function recovery,wound healing rate and lesion clearance were compared between the two groups.Results The bleeding volume during operation and drainage volume after operation in the observation group were less than those in the control group,and the wound healing rate in the stageⅠwas significantly higher than that in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in operation time,deformity correction,nerve function recovery and total clearance rate of lesion between the two groups(P>0.05).Conclusion Posterior small-incision lesion removal and bone grafting combined with percutaneous pedicle screw fixation can reduce surgical trauma,reduce the bleeding volume and drainage volume,reduce the direct contact between the internal fixator and the wound of tuberculosis focus,improve the wound healing rate and the success rate of operation,and effectively remove the lesion,promote the recovery of nerve function and correction of kyphosis deformity.It can provide a new attempt for the operation treatment of thoracolumbar tuberculosis.