前路及后路手术治疗高龄胸椎结核的临床疗效比较  

Comparison of the Clinicalc Effect between Anterior and Posterior Operation Approach on Thoracic Spinal Tuberculosis in Elderly

作　　者：陈斌[1] 刘社廷[1] 谭震[1] 房佐忠[1] 胡文军[1] 刘晓岚[1] 兰图[1] 彭振宇[1] 易继平[2] 

机构地区：[1]郴州市第一人民医院脊柱外科,湖南郴州423000 [2]郴州市第一人民医院神经内科,湖南郴州423000

出　　处：《现代生物医学进展》2012年第35期6946-6950,共5页Progress in Modern Biomedicine

摘　　要：目的:观察和比较前路及后路手术治疗高龄胸椎结核的临床疗效及其安全性。方法:选择2000年1月～2012年1月我科收治的51例高龄胸椎结核手术患者,其中18例行胸椎前路(A组),33例行胸椎后路(B组)手术治疗。观察和比较两组患者的手术时间、切口长度、出血量、COBB角度改善率、平均住院时间、并发症的发生率和术后生活质量的改善情况。结果:51例患者随访6～70个月,平均58±3个月,全部患者植骨融合,神经功能(Frankel分级)均恢复1～2级。两组患者的手术时间、切口长度、出血量无明显差异(P>0.05)。A组患者的平均住院时间为21.5±4.9天,较B组患者(13±3.5天)显著延长(P<0.05);A组发生肺部感染5例,胸膜破裂并血气胸4例,泌尿系感染1例,伤口延迟愈合4例,而B组发生肺部感染例4例,伤口延迟愈合8例;A组肺部及胸腔并发症的发生率(27.8%、22.2%)较B组(12.1%、0)显著升高(P<0.05)。A组脊柱矫形效果(矫正率21.6%)显著低于B组(47.2%)(P<0.05)。A组生活质量改善20分,B组改善31分。结论:前路及后路手术治疗高龄(年龄>70岁)老年胸椎结核均能取得良好治疗效果;与胸椎前路手术相比,胸椎后路手术可以更加有效地减少并发症,缩短住院时间,改善术后生活质量。Objective： To observe and compare the efficacy and safety between anterior and posterior operation approach on thoracic spinal tuberculosis in elderly.Methods： 51 cases of elderly thoracic spinal tuberculosis were treated by surgery from January 2000 to January 2012,in which 18 cases were treated by anterior thoracic surgery（group A） and 33 cases were treated by posterior surgery（group B）.The operation time,incision length,amount of intraoperative blood loss,COBB angle,hospital stay,the incidence of complications and improvement of quality of life were observed and compared after operation.Results： All patients were followed up with an average 58±3 months（6～70 months）.Bony fusion was obtained in all patients.Spinal injury was improved 1-2 level（Frankel grade）.No significant difference of the operation time,incision length,amount of intraoperative blood loss was found（P0.05）.The hospital stay of group A was 21.5±4.9 days,which was obviously longer than that in group B（13±3.5 days）（P 0.05）.In group A,pulmonary infection occurred in 5 cases,pleural rupture and hemopneumothorax occurred in 4 cases,urinary tract infection occurred in 1 case,wound healing delay occurred in 4 cases,while in group B,pulmonary infection occurred in 4 cases,8 cases of delayed union wound;the lung and chest complication rate（27.8%,22.2%） of group A was significantly higher than those in group B（12.1%,0）（P 0.05）.spinal orthopedic effect of group A（correction rate 21.6%） was lower than group B（47.2%）（P0.05）.The improvement of quality of life in group A was 20 points,which was less than that in the group B（31 points）.Conclusion： Anterior and posterior operation were both effective to thoracic spinal tuberculosis in elderly（age70 years old）.Compared with the thoracic operation way,thoracic posterior operation could effectively reduce the complications,shorten the hospital stay,and improve the quality of life.

关 键 词：高龄 胸椎结核 前 后路手术 临床疗效 安全性 

分 类 号：R529.2[医药卫生—内科学] R681.5[医药卫生—临床医学]