单纯后路术式与单纯前路术式治疗成人胸椎及胸腰段结核5年以上疗效分析  

Posterior-only approach versus anterior-only approach for thoracic and thoracolumbar spinal tuberculosis in adults: minimum 5-year follow-up

作　　者：张鹏辉[1] 王锡阳[1] 张宏其[1] 唐明星[1] 葛磊[1] 邓展生[1] 邓盎[1] 吴天定[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,长沙市410008

出　　处：《中国矫形外科杂志》2016年第7期582-588,共7页Orthopedic Journal of China

基　　金：国家自然科学基金面上项目(编号:81171736)

摘　　要：[目的]对比分析单纯后路术式与单纯前路术式治疗成人活动性胸椎及胸腰段结核5年以上随访结果,探讨单纯后路术式的中长期疗效。[方法]回顾性分析158例成人活动性胸椎及胸腰段结核病例,其中107例行单纯后路病灶清除椎间植骨融合椎弓根螺钉钛棒内固定术（A组）;51例行单纯前路病灶清除椎间植骨融合钉棒/板内固定术（B组）。再将A、B组分为两个亚组：A1组（62例）、B1组（26例）为胸椎结核组（T3~10）;A2组（45例）、B2组（25例）为胸腰段结核组（T11~L2）。对比分析A、B组患者手术时间、术中出血量、VAS评分、功能恢复满意度、并发症等。计算A1、A2、B1、B2组后凸矫正率、矫正角度丢失度数并分别进行统计学分析。[结果]A组手术时间、术中出血量、总的并发症发生率均低于B组,差异有统计学意义（P〈0.05）。A1、A2组矫正率均优于B1、B2组,差异有统计学意义（P〈0.05）。B1、B2组矫正角度丢失度数均大于A1、A2组,且B2组与A2组差异有统计学意义（P〈0.05）。[结论]单纯后路术式治疗胸椎及胸腰段成人脊柱结核,中长期随访结果显示疗效良好;单纯后路术式在手术手术时间,术中出血量,后凸畸形矫正率,后凸角丢失度数,并发症发生率等方面优于单纯前路术式。[Objective] The compare the minimum 5-year follow-up results of posterior-only approach with anterior-only approach in the treatment of thoracic and thoracolumbar spinal tuberculosis in adults,and to discuss the mid-term effectiveness of posterior-only approach. [Methods] The clinical data of 158 patients with active thoracic and thoracolumbar spinal tuberculosis between January 2006 and January 2010 were retrospectively studied. Among these patients,107 cases were treated with posterior-only surgery（ group A） and 51 cases were treated with anterior-only surgery（ group B）. All patients were further divided into four subgroups accoding to the tuberculosis location： thoracic spinal tuberculosis group（ group A1,group B1）,thoracolumbar spinal tuberculosis group（ group A2,group B2）. The operation time,blood loss,postoperative satisfaction,complications were respectively compared between group A and group B. Gorrective rate and loss angle were calculated in group A1,group A2,group B2,group B2,respectively. [Results] The operation time,blood loss,complications in group A were less than those in group B,there was statistically significant difference（ P〈0. 05）. Corrective rate in group A1 and group A2 were superior to those in group B1 and group B2,respectively. Correct loss of group B2 was more than that of group A2,there was statistically significant difference（ P〈0. 05）. [Conclusion] The mid-long term follow-up outcome of posterior-only surgery is satisfying in the management of thoracic and thoracolumbar spinal tuberculosis in adults. In addition,the posterior-only surgery is superior to anterior-only surgery in the operation time,blood loss,the corrective rate of kyphosis,correct loss and complication incidence.

关 键 词：单纯后路 脊柱结核 胸椎 胸腰段 疗效 

分 类 号：R687.3[医药卫生—骨科学]