减压固定与单纯减压治疗胸腰椎结核脊髓损害

Decompression combined with instrumented fusion versus simple decompression for treatment of thoracolumbar tuberculosis accompanied with spinal cord impairment

[目的]比较减压固定与单纯减压治疗胸腰椎结核合并脊髓损害的临床效果。[方法]回顾性分析2015年2月~2018年2月本院手术治疗的胸腰椎结核患者84例,其中,42例行减压固定术,42例行单纯减压术。比较两组患者围手术期、随访和影像资料。[结果]两组患者均顺利手术,术中无血管、神经和内脏损伤等严重并发症。减压固定组手术时间、术中失血量、切口长度、术中透视次数和住院时间均显著大于单纯减压组(P<0.05)。减压固定组的下地行走时间和完全负重活动时间均显著早于单纯减压组(P<0.05)。随时间推移,两组患者的VAS和ODI评分显著减小(P<0.05),而ASIA评级显著改善(P<0.05)。末次随访时,减压固定组的VAS评分[(1.72±0.53) vs (2.21±0.59),P<0.05]、ODI评分[(3.28±0.89) vs(4.97±1.12),P<0.05]和ASIA评级[A/B/C/D/E,(0/0/2/3/37) vs (0/0/5/9/28),P<0.05]均显著优于单纯减压组。随时间推移,两组患者的ESR和CRP显著下降(P<0.05)。术后减压固定组的ESR和CRP显著低于单纯减压组(P<0.05)。术后减压固定组的局部后凸Cobb角显著低于术前(P<0.05),而单纯减压组术前与术后局部后凸Cobb角的差异无统计学意义(P>0.05)。[结论]与单纯减压相比,减压固定术手术复杂,但有效改善胸腰椎结核患者脊柱稳定性,有利于神经功能的恢复。

[Objective] To compare the clinical outcomes of decompression combined with instrumented fusion(DIF) versus simple decompression(SD) in the treatment of thoracolumbar tuberculosis accompanied with spinal cord impairment. [Methods] A retrospective study was conducted on 84 patients who underwent surgical treatment for thoracolumbar tuberculosis accompanied with spinal cord impariment in our hospital from February 2015 to February 2018. Of them, 42 patients underwent DIF, while the remaining 42 patients received SD. The perioperative, follow-up and imaging data were compared between the two groups. [Results] The patients in both groups were successfully operated on, with no severe complications, such as vascular, nerve and internal organ injuries during the operation. The DIF group was significantly greater than the SD group in operation time, intraoperative blood loss, incision length, frequency of intraoperative fluoroscopy and hospital stay(P<0.05). The DIF group returned to walking and full weight-bearing activity significantly earlier than SD group(P<0.05). The VAS score and ODI score decreased significantly(P<0.05) while the ASIA score improved significantly in both groups over time(P<0.05). At the last follow-up, the DIF group was significantly superior to the SD group regarding to VAS score [(1.72±0.53) vs(2.21±0.59), P<0.05], ODI score [(3.28±0.89) vs(4.97±1.12), P<0.05] and ASIA grades [A/B/C/D/E,(0/0/2/3/37) vs(0/0/5/9/28), P<0.05]. The ESR and CRP in the two groups decreased significantly over time(P<0.05). The DIF group had significantly lower ESR and CRP than those of the SD group postoperatively(P<0.05). The local kyphotic Cobb angle of the DIF group decreased significantly compared with that before the operation(P<0.05), whereas the local kyphotic Cobb angle of the SD group did not change significantly after the operation compared with that before operation(P>0.05). [Conclusion] Compared with simple decompression, the decompression combined with instrumented fusion is more complicated, but does effectively improve the stability of the spine, which is beneficial to the recovery of nerve function of thoracolumbar tuberculosis accompanied with spinal cord impairment.