单纯后路经椎间孔或椎弓根入路治疗胸腰椎结核的疗效分析

Effectiveness of single posterior transforaminal/transpedicular approach in the treatment of thoracolumbar spinal tuberculosis

目的分析单纯后路经椎间孔或椎弓根病灶清除、植骨融合、内固定治疗胸腰椎结核的疗效。方法回顾分析经手术治疗胸腰椎结核患者47例的临床随访资料,其中前路病灶清除、后路内固定组(前后联合组)25例,单纯后路经椎间孔或椎弓根病灶清除、内固定组(后路组)22例。比较两组手术时间、术中出血量、住院时间及术后并发症,患者术前及术后、末次随访时血沉(ESR)、疼痛视觉模拟评分(VAS)、局部后凸角变化(Cobb角)、美国脊柱损伤协会(ASIA)神经功能分级。结果后路组的手术时间、术中出血量及住院时间均少于前后联合组(P<0.01)。两组患者术后及末次随访时ESR、VAS、Cobb角较手术前均明显改善(P<0.01);两组间比较,术后后路组的ESR及VAS均比前后联合组低(P<0.01)。后凸畸形矫正率后路组比前后联合组更好(P<0.01)。末次随访两组伴有神经功能障碍的患者ASIA分级较术前均有1～2级改善。结论单纯后路治疗胸腰椎结核可以有效缓解脊神经压迫,纠正畸形,重建脊柱的稳定,具有手术时间短、出血少、创伤小等优点,是一种安全、有效的手术方式。

Objective To explore the effectiveness of single posterior transforaminal/ transpedicular debridement,bone grafting,and instrumentation in the treatment of thoracolumbar spinal tuberculosis.Methods The clinical and follow-up data of 47 patients with thoracolumbar spinal tuberculosis who have received surgeries were retrospectively analyzed.Among them,25 patients underwent anterior debridement and posterior instrumentation (AP-approach Group),and 22 patients underwent single posterior transforaminal/transpedicular debridement and instrumentation (P-approach Group).The operation time,intraoperative blood loss,hospital stay and postoperative complication of the two groups,and the erythrocyte sedimentaion rate (ESR),visual analogue scale (VAS),Cobb angle and American Spinal Injury Association (ASIA) neurological classification of the patients before and after the operation as well as last follow-up were recorded and compared. Results In terms of the operation time,blood loss,and the hospital stay,the P-approach Group was significantly less than the AP-approach Group (P<0.01).The ESR,VAS and Cobb angle after the operation and at the last follow-up of both groups were significantly improved compared with those before the operation (P<0.01).After the operation,the ESR and VAS in the Papproach Group were decreased significantly (P<0.01) compared with the AP-approach Group (P<0.01).The kyphosis correction rate in the P-approach Group was improved significantly compared with the AP-approach Group after the operation (P<0.01).The ASIA classification of the patients complicated with neurological deficits in the two groups at the last follow-up was increased by 1-2 grades compared with that before the operation.Conclusion Single posterior transforaminal/transpedicular approach is a safe and effective surgical procedure for the treatment of thoracolumbar spinal tuberculosis,which can effectively relieve spinal nerve compression,correct the spinal deformity,reconstruct a stable spine and is characterized as short operation time,less bleeding and less trauma.