三种手术方式治疗胸腰段脊柱结核的疗效分析

Curative effect of three surgical methods on thoracolumbar spinal tuberculosis

目的观察单纯前路手术、单纯后路手术及前后路联合手术治疗胸腰段脊柱结核的有效性和安全性,探讨胸腰段脊柱结核术式选择的适应证。方法回顾性分析陆军军医大学第一附属医院2000年1月至2015年1月经手术治疗的85例胸腰段脊柱结核患者的临床资料。根据病变类型选择不同的手术方式,其中行一期单纯前路手术的25例患者设为前路组,行一期前后路联合手术的26例患者设为联合组,行单纯后路手术的34例患者设为后路组。对3组患者的临床指标(手术时间、出血量、VAS评分、ODI、ASIA神经功能评级)、矢状位伤椎后凸角(Cobb角)、实验室指标(ESR)、影像学结果进行观察分析。结果术后随访24~60个月,平均31个月。所有患者术后均未见病灶复发,术后3个月ESR均恢复至正常水平,末次随访时均获得植骨融合,无严重并发症。联合组手术时间、出血量均长/多于前路组及后路组,差异具有统计学意义(P<0.05)。末次随访时3组患者ASIA神经功能评级、VAS评分及ODI均较术前明显好转(P<0.05),Cobb角均较术前改善(P<0.05)。联合组的矫正效果优于前路组及后路组,差异具有统计学意义(P<0.05)。结论三种手术方式均能取得理想的疗效,具体的术式选择应根据患者病变的性质、范围及全身情况决定。

Objective To observe the efficacy and safety of simple anterior approach,simple posterior approach and combined anterior and posterior surgery in the treatment of thoracolumbar tuberculosis,and to explore the indications of the selection of surgical methods for thoracolumbar tuberculosis.Methods A retrospective analysis was performed on the clinical data of 85 patients with thoracolumbar tuberculosis treated by surgery in the First Affiliated Hospital of Army Medical University from January 2000 to January 2015.Different surgical methods were selected according to the lesion type,25 patients who underwent simple anterior approach surgery were set as anterior group,26 patients who underwent combined anterior and posterior surgery were set as combined group,34 patients who underwent simple posterior approach surgery were set as posterior group.The clinical indicators(operation time,blood loss,VAS score,ODI,ASIA neurological rating),Cobb angle,laboratory indexes(ESR),the imaging results of three groups were analyzed.Results All patients were followed up for 24 to 60 months,with an average of 31 months.No recurrence was observed in all patients,and ESR returned to the normal level 3 months after surgery.At the last follow-up,bone graft fusion was achieved in all three groups without serious complications.The operation time and blood loss in combined group were longer/more than those in the other two groups,and the differences were statistically significant(P<0.05).At the last follow-up,ASIA neurological rating,VAS score and ODI of the patients in the three groups were significantly better than those before surgery(P<0.05),the Cobb Angle was significantly improved compared with that before surgery(P<0.05).The deformity correction effect of combined group was better than those of the other two groups,and the differences were statistically significant(P<0.05).Conclusion All the three surgical methods can achieve ideal curative effect.The specific surgical method should be determined according to the nature and scope of the lesions and general condition of patients.