不同手术方式治疗腰骶椎结核的效果比较  

Curative effects of different surgical methods in patients with lumbosacral tuberculosis

作　　者：冉博[1] 刘洪文[1] 张锐东[1] 张尊[1] 

机构地区：[1]内蒙古医科大学第三附属医院骨科,内蒙古包头014010

出　　处：《中国医学前沿杂志（电子版）》2015年第10期94-97,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨不同手术方式治疗腰骶椎结核的效果。方法选取2010年1月至2013年12月本院收治的腰骶椎结核患者102例为研究对象。根据手术方式不同将其分为A、B、C三组,A、B组患者分别采用前路、后路病灶清除植骨融合内固定术治疗,C组患者采用后路钉棒内固定联合前路病灶清除植骨融合术治疗。采用日本骨科学会(JOA)下腰痛手术疗效评价标准评价手术治疗效果。术后3天拍摄床旁腰椎正侧位片,观察内固定及植骨稳定情况,评估下床时间。随访2年,每3个月复查X线胸片、红细胞沉降率(ESR)、C反应蛋白(CRP)水平及肝肾功能。结果 A、B、C三组患者优良率分别为86.67%、88.24%和86.84%,组间比较差异均无显著性(P>0.05)。A、B组患者手术时间、术中出血量均显著低于C组(P<0.05),三组患者住院费用、住院时间、术前、术后1周ESR、ESR恢复正常时间、植骨融合时间比较均无显著差异(P>0.05),术后1周及末次随访腰骶角均较术前明显增大(P<0.05),末次随访时均有不同程度的丢失,丢失度数三组间比较无显著差异(P>0.05)。结论综合评估腰骶椎结核患者术前病情,根据手术适应证选择不同手术方式均有较好的临床疗效,但后路病灶清除植骨融合内固定术操作简便,且术中出血量少,手术时间短,临床可能更倾向于采用此种方法治疗腰骶椎结核。Objective To investigate the curative effects of different surgical methods in patients with lumbosacral tuberculosis.Method 102 patients with lumbosacral tuberculosis in our hospital from January 2011 to December 2014 were selected as the research objects.All patients were divided into group A,group B and group C.Patients in group A were given anterior lesions cleared and bone graft fusion treatment.Patients in group B were given posterior lesions cleared and bone graft fusion treatment.Patients in group C were treated by posterior screw rod fixation with anterior lesion clearance bone graft fusion therapy.Japanese orthopaedic association（JOA） was used to evaluate surgical treatment effect.Three days after surgery,lumbar positive side was used to evaluate stable internal fixation.Followed up for two years,X-ray chest radiograph,blood sedimentation,C-reactive protein（CRP） and liver and kidney function were reviewed every three months.Result The excellent rate in group A,B,C were 86.67%,88.23% and 86.84% respectively.The differences was not significant（P〉0.05）.The operation time and intraoperative blood loss in group A and group B were lower than group C（P〈0.05）.The hospitalization costs,length of stay,ESR of preoperative and postoperative one weeks,ESR became normal,bone graft fusion time among the three groups had no significant difference（P〉0.05）.The lumbosacral angle postoperative one week and the last follow-up were higher than preoperative（P〈0.05）.There was no difference of lumbosacral angle loss the last follow-up among the three groups（P〉0.05）.Conclusion For patients with lumbosacral tuberculosis,adaptable operation according to preoperative imageological examination has better clinical curative effect.Posterior lesions cleared and bone graft fusion treatment with less blood loss,shorter operation time is inclined to adopt by clinical.

关 键 词：腰骶椎 手术方式 植骨融合术 

分 类 号：R687.3[医药卫生—骨科学]