后路长节段和短节段固定治疗中段胸椎结核的疗效比较

Comparison of long-segment and short-segment fixation through the posterior approach in the treat-ment of mid-thoracic spinal tuberculosis

目的研究一期后路病灶清除、椎间植骨长节段固定或短节段固定治疗中段胸椎结核的疗效。方法回顾性研究2010年1月至2018年10月符合纳入标准的51例中段胸椎结核患者,年龄21~72岁,平均(46.3±13.5)岁。所有患者行一期后路病灶清除、椎间植骨椎弓根螺钉内固定术治疗,其中26例采用长节段固定(A组),25例采用短节段固定(B组),比较两组的临床疗效。结果两组患者均手术顺利,无严重术后并发症。A组的手术时间明显长于B组,术中出血量明显多于B组(P<0.05)。A组随访60~102个月,平均(75.5±11.8)个月;B组随访60~108个月,平均(76.8±11.6)个月。术后两组的红细胞沉降率(erythrocyte sedimentaion rate,ESR)、疼痛视觉模拟评分(visual analogue scale,VAS)、神经功能均较术前明显改善;根据Kirkaldy-Willis标准A组和B组优良率分别为92.3%和92%(P>0.05)。A组后凸Cobb角术前平均33.6°±4.3°,术后下降为22.1°±2.9°(P<0.05),矫正率为44.2%±4.9%,末次随访丢失1.1°±0.8°;B组术前后凸Cobb为32.8°±5.1°,术后降低至21.6°±3.2°(P<0.05),矫正率为44.5%±4.5%,末次随访丢失1.1°±0.7°。两组患者术前、术后、末次随访后凸Cobb角、矫正率、术后角度丢失比较均无统计学差异(P>0.05)。平均融合时间A组为(10.8±2.1)个月,B组为(11.0±2.0)个月,两组比较无统计学差异(P>0.05)。结论一期后路长节段或短节段固定治疗中段胸椎结核均能明显改善后凸畸形和神经功能损害,显著提高患者的生活质量,但短节段固定可减少失血量并缩短手术时间,适合有手术适应证的中段胸椎结核患者。

Objective To compare the efficacy of long-segment and short-segment fixations via the posterior approach for mid-thoracic spinal tuberculosis in adults.Methods A retrospective study was conducted on 51 patients with mid-thoracic spinal tuberculosis who met the inclusion criteria from January 2010 to October 2018.The patients underwent one-stage posterior debridement,interbody fusion,and instrumentation.Among them,26 patients(group A)performed long-segment fixations,while short-segment fixations were performed for the other 25 patients(group B).Clinical efficacy of the two groups was compared.Results The follow-up time for group A and B was 60~102(75.5±11.8)months and 60~108(76.8±11.6)months respectively.The operative time was significantly shorter and the intraoperative blood loss was significantly less in group B(P<0.05).The visual analogue scale(VAS)and neurological function of group A and B were signifi-cantly improved compared with preoperative ones(P<0.05).According to Kirkaldy-Willis criteria,the excellent and good rate of group A and B was 92.3%and 92%respectively without statistically significant difference.In group A,the kyphosis Cobb angle decreased from 33.6°±4.3°preopeartively to 22.1°±2.9°post opeartively(P<0.05)with the correction rate of 44.2%±4.9%and the correction loss of 1.1°±0.8°.The kyphosis Cobb angle in group B significantly decreased from 32.8°±5.1°preopeartively to 21.6°±3.2°postopeartively(P<0.05)with the correction rate of 44.5%±4.5%and the correction loss of 1.1°±0.7°.There was no difference bewteen two groups(P>0.05).Conclusion Both long-segment and short-segment fixation can significantly relieve kyphotic deformity and neurological impairment,and improve patients'quality of life.Moreover,short-segment fixation led to less blood loss and shorter operative time in patients with suitable indications.