胸腰椎结核前路与后路病灶清除融合固定比较

Anterior versus posterior approach debridement and instrumented fusion for thoracolumbar tuberculosis

[目的]比较前路与后路手术治疗胸腰椎结核的临床效果。[方法]回顾性分析本院2015年1月—2020年10月手术治疗的103例胸腰椎脊柱结核患者的临床资料。根据医患沟通结果,39例采用前路手术(前路组),64例采用后路手术(后路组),比较两组围手术期情况、随访及影像资料。[结果]所有患者均顺利完成手术,前路组手术时间[(136.7±19.2)min vs(108.7±15.6)min,P<0.05]、切口总长度[(23.0±3.8)cm vs(14.6±3.5)cm,P<0.05]、术中出血量[(558.7±42.7)ml vs(408.8±35.8)ml,P<0.05]均显著大于后路组,术中透视次数[(3.5±1.5)次vs(6.7±2.1)次,P<0.05]显著少于后路组。前路组早期并发症发生率显著高于后路组(15.4%vs 6.3%,P<0.05)。随访时间平均(29.6±10.4)个月,两组临床愈合时间的差异无统计学意义(P>0.05)。随时间推移,两组患者VAS、ODI、JOA评分均显著改善(P<0.05),ASIA评级无显著变化(P>0.05),相应时间点,两组VAS、JOA、ODI评分及ASIA评级的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时,两组患者椎管面积、后凸Cobb角、病灶活动情况均显著改善(P<0.05),相应时间点,两组间椎管面积、后凸Cobb角、病灶活动情况的差异均无统计学意义(P>0.05)。[结论]前路手术和后路手术均为胸腰椎结核有效的治疗方式选择,后路手术创伤相对较小,具有一定的优势。

[Objective]To compare the clinical outcomes of anterior versus posterior approach debridement and instrumented fusionsfor thoracolumbar tuberculosis.[Methods]A retrospective study was performed on 103 patients who received surgical treatment for thoraco-lumbar tuberculosis in our hospital from January 2015 to October 2020.According to doctor-patient communication,39 patients underwentanterior-approach surgery(the anterior group),while the remaining 64 cases underwent posterior-approach surgery(the posterior group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had corresponding sur-gical procedures performed successfully,the anterior group proved significantly greater than the posterior group in terms of operation time[(136.7±19.2)min vs(108.7±15.6)min,P<0.05],the total incision length[(23.0±3.8)cm vs(14.6±3.5)cm,P<0.05],intraoperative blood loss[(558.7±42.7)ml vs(408.8±35.8)ml,P<0.05],regardless of the fact thar the former had significantly less intraoperative fluoroscopy timesthan the latter[(3.5±1.5)times vs(6.7±2.1)times,P<0.05].In addition,the incidence of early complications in the anterior group was signifi-cantly higher than that in the posterior group(15.4%vs 6.3%,P<0.05).The follow-up period lasted for a mean of(29.6±10.4)months,andthere was no significant difference in clinical healing time between the two groups(P>0.05).The VAS,ODI and JOA scores were significant-ly improved in 2 groups(P<0.05),while ASIA grade for neurological function remained unchanged over time in both groups(P>0.05),whichwere not statistically significant between the two groups at any time points accordingly(P>0.05).With respect of imaging,the spinal canal ar-ea,local kyphotic Cobb angle and lesion state were significantly improved in both groups at the last follow-up compared with those preopera-tively(P<0.05),whereas all which were not statistically significant between the two groups at any time points accordingly(P>0.05).[Conclu-sion]Both anterior and posterior debridement and instrumented fusions are effective options for the treatment of thoracolumbar tuberculosis,by comparison,the posterior surgery has certain advantages of less trauma over the anterior counterpart.