五种不同的手术方式治疗胸腰椎结核的比较研究  

Comparison among five different ways in treatment of thoracic or lumbar tuberculosis

作　　者：陆晓生[1] 赵劲民[2] 彭昊[3] 凌尚准[1] 韦文[1] 

机构地区：[1]百色市人民医院骨科,广西壮族自治区533000 [2]广西医科大学第一附属医院骨科 [3]武汉大学人民医院骨科

出　　处：《脊柱外科杂志》2013年第2期86-91,共6页Journal of Spinal Surgery

基　　金：百色市科学研究与技术开发计划项目(百科计0908027)

摘　　要：目的比较5种手术方式治疗胸腰椎结核的临床效果。方法回顾分析分别采用5种手术方式治疗的156例胸腰椎结核患者:经皮微创病灶清除灌洗及局部化疗(A组),经前路病灶切除、椎体间植骨融合并内固定术(B组),行前路病灶清除、后路植骨融合内固定术(C组),行后路病灶清除、植骨融合内固定术(D组),行前路病灶清除、植骨融合内固定联合后路内固定(E组)。通过比较各组患者手术时间、术中出血量、手术前后Oswestry功能障碍指数(Oswestry disability index,ODI)及后凸角的改变对各种术式进行疗效评估。结果患者均顺利手术。手术时间、术中出血量、单病种总医疗费用等指标A组与各组比较差异均有统计学意义(P<0.01);其余4组间比较差异无统计学意义(P>0.05)。各组平均随访至少15个月,未发现复发。各组术后ODI及后凸角角度与术前相比,差异有统计学意义(P<0.01);组间比较差异无统计学意义(P>0.05)。结论 CT引导下经皮微创技术与各开放手术疗效相近,具有手术时间短、出血少、费用低等优点。传统各术式差异不明显,应根据个体情况选择。Objective To compare clinical outcomes of 5 different ways in treatment of thoracic or lumbar tuberculosis. Methods A total of 156 patients with thoracic or lumbar tuberculosis were retrospectively analyzed. According the surgical procedures, they were divided in 5 groups： percutaneous minimally invasive focal debridement with local chemotherapy in Group A; anterior debridement, interbody autografting and anterior internal fixation in Group B ; anterior debridement and posterior bone grafting and fusion in Group C ; posterior debridement, bone grafting and posterior internal fixation in Group D ; anterior debridement, interbody autografting and posterior internal fixation in Group E. Operation time, blood loss and other indicators were analyzed. Therapeutic effect was assessed by Oswestry disability index （ODI） and kyphotic angle. Results The mean operation time, intraoperative blood loss, and the medical cost had significant differences between Group A and the other 4 groups （P 〈 O. 01 ） ; but no significant differences existed among the other 4 groups （P 〉 O. 05 ）. The average follow- up periods of 5 groups were over 15 months. No patient relapsed. The differences of ODI and kyphotic angle of 5 groups before and after treatment were statistical （P 〈 0.01 ）. Conclusion The procedures of percutaneous minimally invasive intubation irrigation under CT guidance has the similar therapeutic effect with other 4 methods, but has advantages of shorter operative time, less blood loss and lower medical cost. Therapeutic effect is similar among the others 4 traditional methods, the suitable clinical protocols should be based on individual cases.

关 键 词：胸椎 腰椎 结核 脊柱 外科手术 

分 类 号：R529.23[医药卫生—内科学]