前路和后路手术治疗胸腰椎结核的比较

Comparison of clinical outcomes of anterior procedures versus posterior surgeries for thoracolumbar tuberculosis

[目的]比较前路、后路治疗胸腰椎结核的远期临床疗效。[方法]回顾自2009年9月~2017年9月手术治疗的胸腰椎结核、且随访16个月以上的86例患者。根据入路,分为前路手术组44例、后路手术组42例。比较两组患者的围手术期、随访和影像资料。[结果]所有患者顺利完成手术。前路组平均住院时间、手术时间和出血量优于后路组(P<0.05)。86例患者获得16~108个月随访,随访过程中前路组2例窦道形成,经换药后痊愈;后路组窦道形成和伤口渗液8例,1例清创缝合,其余7例经过换药痊愈;2例是内固定松动,但不影响稳定性,未处理。前路手术并发症发生率4.55%,而后路并发症发生率23.81%,两组间差异有统计学意义(P<0.05)。术后两组患者的Frankel指数均较术前显著改善,不同时间点差异有统计学意义(P<0.05)。随术后时间推移,ODI评分和VAS评分均显著减少,不同时间点差异均有统计学意义(P<0.05)。但是相同时间点,两组间在Frankel指数、ODI和VAS评分的差异均无统计学意义(P>0.05)。术后1个月,两组患者ESR和CRP均较术前显著降低,且在末次随访时进一步降低,不同时间点间差异有统计学意义(P<0.05);但相应时间点,两组间ESR和CRP的差异均无统计学意义(P>0.05)。术后1个月,两组患者后凸Cobb角均较术前显著减少,差异有统计学意义(P<0.05);前路组后凸矫形率为(71.34±28.64)%,而后路组为(83.96±14.35)%,两组差异有统计学意义(P<0.05)。末次随访时,两组后凸畸形矫正均略有丢失,但两组间差异无统计学意义(P<0.05)。[结论]前、后两种入路手术均可有效治疗胸腰结核,相比之下,前路手术创伤小,并发症少。

[Objective] To compare the clinical outcomes of anterior procedures versus posterior surgeries for thoracolumbar tuberculosis. [Methods] A retrospective study was done on 84 patients who underwent surgical treatments for thoracolumbar tuberculosis from September 2009 to September 2017. According to the surgical approaches applied, 44 patients had debridement of the lesions with or without instrumentation througth anterior approaches, while the remaining 42 patients received lesion debridement combined with instrumented fusion through the posterior approaches. The perioperative, follow-up, laboratory test and radiographic data were compared between the two groups. [Results] All the patients in both groups had operation performed successfully. The anterior groups proved significantly superior to the posterior group regarding operation time, intraoperative blood loss and hospital stay(P<0.05). During the follow-up period of 16-108 months, fisula formation was noted in 2 case of the anterior group, which healed by dressing changes. By contract, fisula or incision exudation was found in 8 cases of the posterior group, one of which cured after debridement and 7 healed by dressing changes, and implant loosening was noted in 2 cases, which did not impact the spinal stability and not be managed. The complication rate was of 4.55% in the anterior group, whereas 23.81% in the posterior group, which was statistically significant(P<0.05). The Frankel indexes significantly improved in both groups postoperatively compared with those before operation(P<0.05), with significant differences among different time points(P<0.05). As time went postoperatively, the ODI and VAS scores significantly decreased in both groups(P<0.05). However, there were no statistically significant differences between two groups regarding to Frankel index, ODI and VAS scores at any matching time point(P>0.05).In addition, the ESR and CRP significantly decreased postoperatvely, and further decreased as time went postoperatively in both groups(P<0.05), although no significant differences were noticed between the two group at any matching time point(P>0.05). The Cobb’s angles of kyphosis in both groups significantly decreased after operation(P<0.05), with the correction rate of kyphosis of(71.34±28.64) % in the anterior group, whereas(83.96±14.35) % in the posterior group, which was statistically significant(P<0.05). To the latest follow up, slight loss of correction happened in both group, which was not statistically significant(P>0.05). [Conclusion] Both anterior and posterior surgeries are effective for treatment of thoracolumar tuberculosis. By comparison, the anterior procedures have advatages of minimizing iatrogenic trauma, and reducing complication over the posterior surgeries.