三种入路术式治疗胸腰椎脊柱结核对比

Comparison of debridement and instrument fusion through three approaches for thoracolumbar tuberculosis

[目的]比较三种入路术式治疗胸腰椎脊柱结核的临床效果。[方法]回顾性分析2016年3月~2019年3月,本院收治的60例胸腰椎脊柱结核患者的临床资料。其中,22例采用单纯前路病灶清除固定融合,17例采用单纯后路病灶清除固定融合,21例采用前、后路联合病灶清除固定融合。比较三组患者的围手术期、随访和影像资料。[结果]联合组手术时间、术中出血量及住院时间均显著大于前路组及后路组(P<0.05)。早期并发症前路组6例,后路组4例,联合组3例,经相应处理,均未导致严重不良后果。三组患者随访12~24个月。末次随访时,三组患者ASIA评级,VAS、ODI和JOA评分均较术前显著改善(P<0.05);相应时间点,三组间上述指标的差异均无统计学意义(P>0.05)。影像方面,前路组的术后后凸矫正率显著小于后路组和联合组(P<0.05),而前路组末次随访时后凸矫正丢失率显著大于后路组和联合组(P<0.05)。[结论]三种不同入路手术方式治疗胸腰椎脊柱结核均取得较好疗效,相比之下,单纯前路手术后凸畸形矫正差。

[Objective] To compare the clinical outcomes of debridement and instrumented fusion through three approaches for thoracolumbar tuberculosis. [Methods] A retrospective study was conducted on 60 patients who underwent surgical treatment for thoracolumbar tuberculosis from March 2016 to March 2019 in our hospital. Of them, 22 patients received debridement and instrumented fusion through the anterior approach only, 17 patients had surgical procedures performed through the posterior approach only, and the remaining 21 patients underwent the surgical operations through the anterior combined with the posterior approaches. The perioperative, follow-up and radiographic documents were compared among the 3 groups. [Results] The combined group consumed significantly longer operation time, associated with significantly greater intraoperative bleeding and longer hospital stay than the anterior and the posterior groups(P<0.05). At the latest follow-up lasted for 12 to 24 months the ASIA grade for neurological function, VAS, ODI and JOA scores significantly improved compared with those before operation in all the 3 groups(P<0.05). However, no statistical differences were found among the 3 groups in aforesaid items at any corresponding time point(P<0.05). With regard to radiographic assessment, the anterior group had significantly less correction rate of local kyphotic deformity in term of Cobb’s angle than the posterior group and the combined group postoperatively(P<0.05),whereas the anterior group got significantly greater loss of the kyphotic correction than the posterior and combined groups at the latest follow up(P<0.05). [Conclusion] All surgical interventions through the 3 approaches achieve satisfactory clinical outcomes for thoracolumbar tuberculosis. By contrast, the surgical procedure through the anterior approach is inferior to those through the posterior and combined approaches in term of kyphotic correction.