不同入路手术治疗脊柱结核的对比研究

A comparative study on effects of different surgical approaches in the treatment of patients with spinal tuberculosis

目的探讨理想的脊柱结核的外科手术治疗方案。方法回顾性分析2012年5月至2014年5月行手术治疗的脊柱结核患者53例,所有患者均采用一期病灶清除植骨内固定术治疗。按照入路方法不同分为前入路组(n=27)和后入路组(n=26),观察两组手术时间、术中出血量、并发症、神经功能恢复情况、术后1年Cobb角平均值、影像学评价和功能评价等。结果后入路组术后1年Cobb角平均值小于前入路组(P<0.01);两组手术时间、术中出血量、并发症以及神经功能恢复情况差异无统计学意义(P>0.05);两组影像学评分优良率比较,差异无统计学意义(χ2=0.574,P>0.05);两组功能评分优良率比较,差异无统计学意义(χ2=0.148,P>0.05)。结论在治疗脊柱结核手术中,前路或者后路病灶清除植骨内固定术均可取得良好的疗效。

Objective To explore ideal surgical treatment for spinal tuberculosis. Methods Clinical data of 53 spinal tuberculosis patients who underwent operation during May,2012 to May,2014 were retrospectively analyzed. All patients who were treated with one-stage radical debridement,bone grafting and internal fixation,were divided into anterior approach group( n = 27) and posterior approach group( n = 26). Then,operative time,intraoperative blood loss,complications,recovery of neurological function,average value of Cobb angle one year after surgery,imaging evaluation and function evaluation of the two groups were compared. Results The average value of Cobb angle one year after surgery in the posterior approach group was smaller than that in the anterior approach group( P < 0. 01). Difference of operative time,intraoperative blood loss,complications and recovery of neurological function in the two groups was not statistically significant( P > 0. 05). In addition,difference of excellent and good rate of imaging evaluation scores was not statistically significant between groups( χ2= 0. 574,P >0. 05),so was difference of excellent and good rate of function evaluation( χ2= 0. 148,P > 0. 05). Conclusion Both anterior and posterior radical debridement,bone grafting and internal fixation are viable surgical options for spinal tuberculosis.