胸腰椎脊柱结核不同手术入路的临床效果对比

Selection and effect comparison of different surgical approaches for thoracolumbar spinal tuberculosis

目的比较采用不同手术入路治疗胸腰椎脊柱结核的临床效果。方法回顾性分析2015年9月至2018年12月南京中医药大学附属南京市中西医结合医院收治的80例胸腰椎脊柱结核患者的临床资料,根据手术入路的不同分为前路组(33例)、后路组(26例)及联合入路组(21例)。比较三组患者的手术情况,手术前后的红细胞沉降率、C反应蛋白水平、Cobb角及美国脊髓损伤协会(American Spinal Injury Association,ASIA)脊髓损伤分级情况。结果联合入路组的手术时间、术中出血量及住院时间均大于前路组及后路组,差异有显著性(P<0.05)。三组患者术后红细胞沉降率及C反应蛋白水平均较术前明显降低,差异有显著性(P<0.05),但术前及术后三组间比较差异均无显著性(P>0.05)。前路组术后及末次随访时Cobb角及丢失率均大于后路组和联合入路组,矫正率低于后路组和联合入路组,差异有显著性(P<0.05)。三组患者术后ASIA分级均较术前好转,差异有显著性(P<0.05),但三组间比较差异无显著性(P>0.05)。结论三种不同的手术入路治疗胸腰椎脊柱结核均可取得较好疗效。掌握手术适应证,根据患者实际情况选择相应的术式有助于有效清除病灶、重建脊柱稳定性。

Objective To research the selection and effect comparison of different surgical approaches for thoracolumbar spinal tuberculosis.Method The clinical data of 80 elderly patients with thoracolumbar spinal tuberculosis from September 2015 to December 2018 were retrospectively analyzed.Grouping based on different surgical methods:Anterior Group(n=33),posterior group(n=26)and combined approach group(n=21).The surgical status,ESR,C-reactive protein level,Cobb angle and spinal cord injury grading(ASIA)before and after surgery were compared between the three group.Result The operation time,intraoperative bleeding volume and hospitalization time of the combined approach group were longer than those of the other two groups,with statistical significance(P<0.05).ESR and C-reactive protein levels in the three groups were better than those before(P<0.05),but there was no significant difference between the three groups(P>0.05).The Cobb angle and loss rate in the anterior group were higher than those in the other two groups,and the correction rate was lower than that in the other two groups,with statistical significance(P<0.05).The ASIA scores of the three groups were better than those before(P<0.05),but there was no significant difference between the three groups(P>0.05).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.