单纯前入路与前后路结合入路手术治疗第5腰椎至第1骶椎结核的疗效比较

Comparison on efficacy of anterior approach surgery versus anterior-posterior approach surgery on tuberculosis of the 5th lumbar spine to 1st sacral spine

目的比较锁定钛板的单纯前路与前后路结合的手术方式治疗第5腰椎(L5)~第1骶椎(S1)结核的有效性。方法抽取2007年6月至2017年6月于湖北中医药大学附属襄阳市中医医院进行手术治疗的腰骶结核患者28例,对其病历资料进行回顾性分析。根据手术入路将纳入患者分为锁定钛板组(16例)和前后路结合组(12例),锁定钛板组患者采用锁定钛板的单纯前路手术治疗,前后路结合组患者采用前后路结合的手术方式进行治疗。分析两组患者的手术时间、术中失血量、住院天数;术后至少随访18个月,比较两组术前、术后及最后1次随访的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)评分、红细胞沉降率(ESR)、C-反应蛋白(CRP)及L5~S1前上缘之间的垂直高度。结果锁定钛板组术中失血量、手术时间、住院天数均少于前后路结合组,(P均<0.05)。两组术前、术后1个月、术后3个月、术后6个月及最后1次随访的VAS评分、ODI评分、CRP、ESR水平比较差异均未见统计学意义(P均>0.05);两组术后1、3、6个月及最后1次随访的VAS评分、ODI评分、CRP、ESR均较术前改善(P均<0.05)。术前、术后即刻及最后1次随访时,两组L5~S1前上缘之间的垂直高度比较差异未见统计意义(P>0.05);两组术后即刻及最后1次随访时的L5~S1前上缘之间的垂直高度大于术前(P<0.001)。两组患者均预后良好,组间比较差异未见统计学意义(P>0.05)。结论锁定钛板的单纯前路手术治疗腰骶结核可以达到与前后路结合手术相同的临床疗效,但其手术时间、术中失血量、住院天数更少。

Objective To compare the efficacy of simple anterior approach and combined anterior-posterior approach with locking titanium plate system in the treatment of tuberculosis of the 5th lumbar spine(L5)to 1st sacral spine(S1).Methods A total of 28 patients with lumbosacral tuberculosis who underwent operation in Xiangyang Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Traditional Chinese Medicine from June 2007 to June 2017 were selected,and their medical records were retrospectively analyzed.According to the surgical approaches,the patients were divided into anterior approach group(AA group,n=16)and combined anterior-posterior approach group(AP group,n=12).The patients in AA group were treated by locking titanium plate system through anterior approach,while the patients in AP group were treated by anterior posterior approach.The operation time,intraoperative blood loss and hospitalization days of the two groups were analyzed.The patients were followed up for at least 18 months.The visual analogue scale(VAS)score,Oswestry disability index(ODI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and the vertical height between L5 and S1 were compared before treatment,after treatment and at the last follow-up.Results The intraoperative blood loss,operation time,and hospital stay in AA group were less than those in AP group(P<0.05).There was no significant difference in VAS score,ODI score,CRP or ESR between the two groups before operation,at 1,3,6 months after operation and the last follow-up(P>0.05).The VAS score,ODI score,CRP and ESR of the two groups at 1,3,6 months and the last follow-up were significantly improved(P<0.05).There was no significant difference in the vertical height of L5-S1 between the two groups before operation,immediately after operation,and at the last follow-up(P>0.05).The vertical height of L5-S1 in the two groups immediately after operation and at the last follow-up was higher than that before operation(P<0.001).Both groups had good prognoses,without significant difference between the two groups(P>0.05).Conclusions Anterior approach with locking titanium plate alone for lumbosacral tuberculosis can achieve the same clinical effect as combined anterior and posterior approach.However,the operation time,intraoperative blood loss,and hospital stay of anterior approach with locking titanium plate are less.