经皮脊柱内镜下病灶清除联合经皮内固定术治疗脊柱结核疗效观察

Curative effect of percutaneous endoscopic debridement combined with percutaneous internal fixation in the treatment of spinal tuberculosis

目的探讨经皮脊柱内镜下病灶清除联合经皮内固定术治疗脊柱结核的疗效。方法选取2016年5月至2018年5月宝鸡市中医医院骨科收治的86例脊柱结核患者作为研究对象。按照随机数表法将患者分为观察组和对照组,每组43例。对照组采用开放后路病灶清除植骨融合内固定手术治疗,观察组采用经皮脊柱内镜下病灶清除联合经皮内固定术治疗。两组患者除手术之外均给予正规四联口服药物抗结核治疗。比较两组患者的手术时间、术中出血量、住院天数、病椎融合时间、治疗前后的红细胞沉降率(ESR)、C-反应蛋白(CRP)水平,以及治疗前后的疼痛视觉模拟评分(VAS)、日本骨科协会评分(JOA)及并发症发生情况。结果两组患者的年龄和性别比较差异均无统计学意义(P>0.05);观察组患者的手术时间、术中出血量、住院天数分别为(130.31±20.22)min、(53.85±17.63)m L、(9.83±1.16)d,明显短于或少于对照组的(177.35±30.82)min、(507.52±36.74)mL、(18.86±1.57)d,差异均有统计学意义(P<0.05),但病椎融合时间两组比较差异无统计学意义(P>0.05);治疗前,两组患者的ESR和CRP水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的ESR、CRP水平均明显下降,且观察组和对照组患者的ESR[(9.18±3.42)mm/h vs(27.84±5.22)mm/h]、CRP[(10.55±3.61)mg/L vs(35.36±5.73)mg/L]水平比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);治疗前,两组患者的VAS、JOA评分比较差异均无统计学意义(P>0.05);治疗后,两组患者的JOA评分明显上升,且观察组患者在术后的JOA评分明显高于对照组[(11.56±3.28)分vs(9.44±2.53)分],差异均有统计学意义(P<0.05);两组患者术后的VAS评分明显下降,且观察组术后VAS评分明显低于对照组[(2.11±0.82)分vs(3.57±0.91)分],差异均有统计学意义(P<0.05);治疗后,观察组患者的总并发症发生率为4.65%,明显低于对照组的18.60%,差异有统计学意义(P<0.05)。结论经皮脊柱内镜下病灶清除联合经皮内固定术治疗脊柱结核可有效控制感染灶,改善患者生活质量,临床疗效显著,值得临床推广应用。

Objective To study the curative efficacy of percutaneous endoscopic debridement combined with percutaneous internal fixation in treatment of spinal tuberculosis.Methods Eighty-six patients with spinal tuberculosis admitted to Baoji City Hospital of Traditional Chinese Medicine from May 2016 to May 2018 were selected as the study subjects,and they were divided into observation group and control group according to the random number table method,with 43 patients in each group.The control group was treated by open posterior debridement,fusion and internal fixation,and the observation group was treated by percutaneous endoscopic debridement combined with percutaneous internal fixation.In addition to surgery,the patients in both groups were given regular quadruple oral drug for anti-tuberculosis treatment.The operation time,intraoperative hemorrhage,length of hospital stay,fusion time,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),Visual Analogue Scale(VAS),Japanese Orthopaedic Association(JOA)scores,and complications were compared between the two groups.Results There was no significant difference in age and gender between the two groups(P>0.05).The operation time,intraoperative hemorrhage,and length of hospital stay in the observation group were(130.31±20.22)min,(53.85±17.63)mL,(9.83±1.16)d,which were significantly shorter or less than(177.35±30.82)min,(507.52±36.74)mL,(18.86±1.57)d in the control group(P<0.05).There was no significant difference in ESR and CRP between the two groups before treatment(P>0.05).After treatment,the ESR and CRP levels of the two groups were significantly decreased,and the ESR and CRP levels of the observation group were significantly lower than those of the control group(P<0.05):ESR,(9.18±3.42)mm/h vs(27.84±5.22)mm/h;CRP,(10.55±3.61)mg/L vs(35.36±5.73)mg/L.Before treatment,there was no significant difference in VAS and JOA scores between the two groups(P>0.05);after treatment,the JOA scores of the two groups increased significantly,and the JOA score of the observation group were significantly higher than that of the control group:(11.56±3.28)points vs(9.44±2.53)points,P<0.05;the VAS scores of the two groups decreased significantly after operation,and the VAS score of the observation group was significantly lower than that of the control group:(2.11±0.82)points vs(3.57±0.91)points,P<0.05.After treatment,the total complication rate of the observation group was 4.65%,which was significantly lower than 18.60%of the control group(P<0.05).Conclusion Percutaneous endoscopic debridement combined with percutaneous internal fixation for the treatment of spinal tuberculosis can effectively control the infection focus,improve the quality of life of patients,and has a significant clinical effect,which is worthy of clinical application.