前路与后路手术治疗胸腰椎结核的临床效果研究

CLINICAL EFFECT OF ANTERIOR AND POSTERIOR SURGERY FOR THORACOLUMBAR TUBERCULOSIS

目的探讨前路和后路病灶清除钛笼植骨融合内固定术治疗胸腰椎结核的临床疗效。方法选取2014年8月—2018年6月在三二〇一医院接受单纯前路或后路手术治疗的74例胸腰椎结核患者临床资料进行回顾性研究。46例行单纯前路病灶清除钛笼植骨融合内固定术(前路组),28例行单纯后路病灶清除钛笼植骨融合内固定术(后路组)。比较二组手术相关指标、病灶清除效率、后凸畸形Cobb角矫正率、神经功能ASIA分级、ODI评分、植骨融合、并发症及结核复发情况。结果后路组手术时间、术中出血量优于前路组,差异有统计学意义(P<0.05),术后住院时间二组差异无统计学意义(P>0.05)。所有病例抗酸染色均为阴性,二组术后引流液结核培养阳性率均明显低于术中结核病灶培养阳性率,差异有统计学意义(P<0.05);前路手术后引流液结核培养阳性率低于后路组,但组间差异无统计学意义(P>0.05)。后路组后凸Cobb角矫正率高于前路组,丢失角度低于前路组,差异有统计学意义(P<0.05)。二组植骨融合时间、Ⅰ~Ⅱ级植骨融合率及神经功能ASIA分级、ODI评分差异无统计学意义(P>0.05)。后路组并发症发生率低于前路组,差异有统计学意义(P<0.05),二组结核复发率无统计学意义(P>0.05)。结论前、后路手术治疗胸腰椎结核均可获得良好的临床疗效,后路手术较前路手术相比,手术创伤小,后凸畸形矫形效果更好。

Objective To investigate the clinical effect of anterior and posterior lesion removal with titanium cage bone graft fusion and internal fixation in the treatment of thoracolumbar tuberculosis.Methods A retrospective study was conducted on the clinical data of seventy-four patients with thoracolumbar tuberculosis who received simple anterior or posterior surgical treatment in the 3201 hospital from August 2014 to June 2018.46 patients underwent simple anterior lesion removal and internal fixation with titanium cage graft fusion(anterior group),28 patients underwent simple posterior lesion removal and internal fixation with titanium cage graft fusion(posterior group).Operative indicators,lesion removal efficiency,Cobb Angle correction rate of kyphosis,ASIA grade of nerve function,ODI score,bone graft fusion,complications and tuberculosis recurrence were compared between the two groups.Results The operative time and intraoperative blood loss in the posterior group were better than those in the anterior group,the difference was statistically significant(P<0.05),and there was no significant difference in postoperative hospital stay between the two groups,there was no statistically significant difference(P>0.05).Acid-fast staining was negative in all cases.The positive rate of tuberculosis culture in postoperative drainage fluid in both groups was significantly lower than that in intraoperative tuberculosis culture,the difference was statistically significant(P<0.05).The positive rate of tuberculosis culture in drainage fluid after anterior surgery was lower than that in the posterior group,but there was no statistically significant difference between groups,there was no statistically significant difference(P>0.05).The correction rate of kyphosis Cobb Angle in the posterior group was higher than that in the anterior group,and the loss Angle was lower than that in the anterior group,the difference was statistically significant(P<0.05).Two groups of bone graft fusion time,Ⅰ-Ⅱbone graft fusion rate and neural function ASIA grading,ODI score difference of no statistical significance,there was no statistically significant difference(P>0.05).The incidence of complications in the posterior group was lower than that in the anterior group,the difference was statistically significant(P<0.05),and there was no statistical difference in the tuberculosis recurrence rate between the two groups,there was no statistically significant difference(P>0.05).Conclusion Both anterior and posterior surgeries for thoracolumbar tuberculosis can obtain good clinical efficacy.Compared with anterior surgeries,posterior surgeries have less surgical trauma and better corrective effect of kyphosis.