不同手术入路治疗老年胸腰椎结核的手术疗效分析

Clinical therapeutic effects comparison of two different surgical approaches in the treatment of thoracolumbar spinal tuberculosis in elderly patients

目的探讨两种不同手术入路治疗老年胸腰椎结核的临床疗效。方法回顾性分析2013年01月至2019年12月安徽医科大学第二附属医院脊柱外科收治的124例老年胸腰椎结核患者的临床资料,其中男性70例,女性54例;年龄(64.7±5.2)岁。按照手术入路分组:前路入路手术组63例;后路入路手术组61例。比较两组的手术时间、术中出血量、住院时间、术前和术后的Cobb角、红细胞沉降率(ESR)、C反应蛋白(CRP)、疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)等指标的差异。结果124例患者获得完整随访,随访时间12~24个月,平均为(16.2±2.6)个月。前路入路手术组和后路入路手术组的手术时间、住院时间和术中出血量比较,差异无统计学意义(P>0.05);末次随访时,前路入路手术治疗组患者术后Cobb角度[(17.1±3.5)°]大于后路手术入路组[(13.4±4.2)°,P<0.05];两组患者术前、末次随访ESR、CRP、VAS评分、ODI指数比较,差异有统计学意义(P<0.05)。末次随访时,所有患者术后脊柱结核病灶未见复发,未发现感染、下肢深静脉血栓、骨不愈合或延迟愈合等并发症。结论两种不同手术入路治疗老年人胸腰椎结核均取得了良好疗效,但是后路入路手术对于脊柱后凸畸形的矫正效果更好。

Objective To investigate the clinical outcome of two different surgical approaches in the treatment of thoracolumbar spinal tuberculosis in elderly patients.Methods A retrospective study was performed on 124 patients with thoracolumbar spinal tuberculosis who underwent two different surgical approaches in the second hospital of Anhui Medical University form January 2013 to December 2019.Patients were divided into two groups according to the different surgical approaches:Anterior approach group(n=63)were treated by anterior surgical approach,and posterior approach group(n=61)were treated by posterior surgical approach.Meanwhile,the operation time,intra-operative blood loss,hospitalization time,Cobb'angle,ESR,CRP,VAS,and ODI were compared between the two groups.Results There was no significant difference between the two groups in terms of operation time,intra-operative blood loss and hospitalization time(P>0.05),and there was significant difference between the two groups in ESR,CRP,VAS and ODI per-operatively and final follow-up.At the final follow-up,the post-operative Cobb's angle of anterior approach group was higher than that of posterior approach group showing significantly difference(P<0.05).No complications of recurrence of spinal tuberculosis,and no complications of infection,deep vein thrombosis,nonunion or delayed union was observed.Conclusion These two different surgical approaches for thoracolumbar spinal tuberculosis showed good clinical outcome in elderly patients,and the posterior approach is better for the correction of kyphosis.