一期后路保留椎板病灶清除治疗单节段胸腰椎结核的短期疗效分析

Analysis of short-term efficacy of one-stage posterior sparing laminectomy for single level thoracolumbar tuberculosis

目的探讨一期后入路保留椎板病灶清除植骨融合内固定治疗单节段胸腰椎结核的可行性及短期临床疗效。方法选取2021年9月至2022年6月在该院接受一期后入路保留椎板病灶清除植骨融合内固定治疗单节段胸腰椎结核的11例患者为研究对象。通过监测C-反应蛋白(CRP)及血沉(ESR)进行结核菌血症和活动性控制的评估,随访视觉模拟量表(VAS)评分和奥斯韦斯特里功能障碍指数(ODI)进行临床功能改善评估,使用美国脊柱损伤协会(ASIA)损伤分级进行神经功能评估,并随访脊柱后凸矫正度的维持。结果11例患者均得以完整随访。平均手术时间(270.91±45.98)min,平均术中出血量(522.72±194.11)mL。随访期间,11例患者均未发生病灶区结核复发,均达到植骨融合,融合时间为术后6~9个月,平均(7.36±1.12)个月。2例术前有神经损伤的患者术后均有恢复。随访期间11例患者未发生与手术相关并发症,术后患者平均CRP、ESR、ODI、VAS评分较术前降低,并在术后12个月时进一步降低;患者因胸腰椎结核所致脊柱后凸均得以矫正,并在末次随访时未见明显角度丢失(P>0.05)。结论一期后入路保留椎板病灶清除植骨融合内固定是治疗单节段胸腰椎结核的一种安全有效的方法。

Objective To explore the feasibility and short-term clinical efficacy of single segment thoracolumbar tuberculosis treated with one-stage posterior approach lamina-sparing decompression.Methods A total of 11 patients with single segment thoracolumbar tuberculosis who underwent one-stage posterior approach preservation of vertebral plate lesion removal,bone graft fusion,and internal fixation treatment in this hospital from September 2021 to June 2022 were selected.C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were monitored to evaluate tuberculosis bacteremia and activity control,visual analogue scale(VAS)score and Oswestry disability index(ODI)were followed up to evaluate the improvement of clinical function,and the American Spinal Injury Association(ASIA)injury scale was used to evaluate neurological function,and the correction of kyphosis was followed up.Results All 11 patients were fully followed up.The average surgical duration is(270.91±45.98)minutes,and the average surgical bleeding is(522.72±194.11)mL.During the follow-up period,none of the 11 patients experienced tuberculosis recurrence,and all 11 patients achieved bone graft fusion.The fusion time was 6-9 months after surgery with an average of(7.36±1.12)months.Two patients with preoperative nerve damage recovered after surgery.During the follow-up period,11 patients did not experience any complications related to surgery.The average CRP,ESR,ODI score,and VAS score of postoperative patients decreased compared to preoperative levels,and further decreased at 12 months after surgery;The patient’s kyphosis caused by thoracolumbar tuberculosis was corrected,and no obvious angle loss was found at the last follow-up(P>0.05).Conclusion One-stage posterior approach lamina-sparing decompression is a safe and effective method for treating single segment thoracolumbar tuberculosis.