两种不同减压置钉术式治疗多节段胸腰椎结核的比较

A comparative study of two different decompression and nail placement methods in the treatment of multi⁃level thoracolumbar tuberculosis

目的比较两种不同减压置钉术式治疗多节段胸腰椎结核(multilevel thoracolumbar tuberculosis,MTB)的临床疗效。方法选择我院脊柱外科收治的MTB患者156例,随机分为两组。观察组采用一期后路经皮椎弓根螺钉固定联合前路小切口病灶清除植骨术治疗;对照组采用一期后路病灶清除植骨内固定治疗。对两组患者术后一般情况、并发症及手术前后VAS评分、ODI指数和Cobb角进行比较。结果两组术后切口均愈合良好,术后症状均缓解。对照组发生脑脊液漏5例、窦道形成2例、结核复发3例,均经相应处理后治愈,观察组无相关并发症出现,两组病例椎间植骨均骨性融合。两组患者术后1周、3、12个月及末次随访的VAS评分、ODI指数及Cobb角与术前相比差异均有统计学意义(P<0.05),两组术后1周和术后3个月的VAS评分、ODI指数及Cobb角相比差异无统计学意义(P>0.05)。但是,两组之间的VAS评分、ODI指数及Cobb角在术后12个月及末次随访相比较,观察组优于对照组(P<0.05)。结论相较于一期后路病灶清除植骨内固定术,采取一期后路经皮椎弓根螺钉结合前路小切口病灶清除植骨术治疗MTB,具有创伤小、不破坏脊柱后方结构、病灶清除彻底、并发症少、远期效果好等优点,值得临床推广。

Objective To compare the clinical efficacy of two different decompression and screw placement procedures in the treatment of multi-segmental thoracolumbar tuberculosis.Methods 156 patients with multisegmental thoracolumbar tuberculosis were randomly divided into two groups.The observation group received one-stage posterior percutaneous pedicle screw fixation combined with anterior small incision debridement and bone grafting;whereas the control group received one-stage posterior debridement,bone grafting and internal fixation.The postoperative general condition,complications,VAS score,GDI index and Cobb angle were compared between the two groups.Results The incision healed in both groups,and the postoperative symptoms were relieved.In the control group,5 patients developed cerebrospinal fluid leakage,2 occurred sinus formation and 3 suffered tuberculosis recurrence,they were cured after corresponding treatment.There were no related complications in the observation group.There were significant differences in VAS score,ODI index and Cobb angle between the two groups at postoperative 1 week and 3,12 months,and the last follow-up(P<0.05).There was no significant difference in VAS score,ODI index and Cobb angle between the two groups at postoperative week 1 or month 3(P>0.05).However,VAS score,ODI index and Cobb angle were better in the observation group than in the control group at postoperative month 12 and at the last follow-up(P<0.05).Conclusions As compared with one-stage posterior debridement and internal fixation,one-stage posterior percutaneous pedicle screw combined with anterior small incision debridement and bone grafting for the treatment of multi-segmental thoracolumbar tuberculosis has the advantages of less trauma,no damage to the posterior structure of the spine,complete focal clearance,fewer complications and better long-term effect,which is’worthy of clinical promotion.