后路经皮内固定联合前路病灶清除植骨融合术治疗胸腰椎结核

Posterior percutaneous fixation combined with anterior debridement,bone grafting and fusion for thoracolumbar tuberculosis

目的探讨后路经皮内固定联合前路病灶清除植骨融合术治疗胸腰椎结核的临床疗效。方法回顾性分析2014年9月-2017年1月收治的40例胸腰椎结核患者资料,其中15例接受后路经皮内固定联合前路病灶清除植骨融合术治疗(A组),25例接受传统后路椎弓根螺钉内固定联合前路病灶清除植骨融合术治疗(B组)。记录并比较2组手术时间、出血量、术后引流量、疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、美国脊髓损伤协会(ASIA)分级、后凸Cobb角矫正情况、植骨融合情况及术后并发症等指标。结果所有手术顺利完成,所有患者随访12~30(15.3±3.2)个月;末次随访时所有患者均获得骨性融合。A组出血量及术后引流量均少于B组,术后早期VAS评分和ODI优于B组,差异均有统计学意义(P<0.05)。6例脊髓功能障碍患者术后ASIA分级获得改善。2组各有1例患者术后出现伤口感染(均为前路切口处)。2组术后3 d及末次随访时Cobb角差异无统计学意义(P>0.05);末次随访时Cobb角丢失角度及矫正率差异无统计学意义(P>0.05)。结论后路经皮内固定联合前路病灶清除植骨融合术治疗胸腰段脊柱结核安全、有效,具有出血少、创伤小等优势。

Objective To explore the curative effect of posterior percutaneous fixation combined with anterior debridement,bone grafting and fusion for thoracolumbar tuberculosis.Methods The clinical data of 40 patients with thoracolumbar tuberculosis from September 2014 to January 2017 were retrospectively reviewed,of whom 15 were treated with posterior percutaneous fixation combined with anterior debridement,bone grafting and fusion(group A) and 25 were treated with posterior conventional fixation combined with anterior debridement,bone grafting and fusion(group B).The operation time,blood loss,postoperative drainage,visual analogue scale(VAS) score,Oswestry disability index(ODI),American Spinal Injury Association(ASIA) classification,kyphosis Cobb’s angle,bone fusion and postoperative complications were compared between the 2 groups.ResultsAll the operations were successfully completed.All the patients were followd-up for 12-30(15.3±3.2)months.All the patients got bone fusion at the final follow-up.The blood loss and postoperative drainage in group A were lower than those in group B,the VAS score and ODI in group A were better than those in group B in the early postoperative period,all with statistically significant differences(P < 0.05).After operation,ASIA classification of 6 patients with spinal dysfunction all significantly improved.At post-operation,1 patient in each group occurred wound infection(all in the anterior incision).There was no significant difference in Cobb’s angle between the 2 groups at postoperative 3 d and the final follow-up.There was no significant difference in Cobb’s angle loss and correction rate at the final follow-up.Conclusion Posterior percutaneous fixation combined with anterior debridement,bone grafting and fusion for thoracolumbar tuberculosis is a safe and effective with the advantages of less blood loss and trauma.