Ⅰ期前路与后路病灶清除内固定治疗胸腰段结核的疗效比较  

Comparision of clinical effects between one-stage anterior and posterior approach in treating thoracolumbar tuberculosis with debridement and internal fixation

作　　者：林斌[1] 戴立林 陈志达[1] 郑勇[1] 

机构地区：[1]解放军第175医院骨科,福建漳州363000

出　　处：《中国骨伤》2017年第9期792-798,共7页China Journal of Orthopaedics and Traumatology

基　　金：军区医学科技创新重点课题(编号:12Z24)~~

摘　　要：目的:比较前路与后路手术治疗胸腰段脊柱结核的临床疗效。方法:对2005年1月至2014年12月手术治疗的97例胸腰段脊柱结核患者回顾性分析,其中男59例,女38例;年龄20~68岁,平均53.7岁;病程1~13个月,平均(6.9±2.3)个月;采用后路手术治疗54例(后路组),前路手术治疗43例(前路组)。观察两组患者的相关指标,包括手术时间、术中及术后出血量、术后住院时间及并发症、VAS评分、ODI评分、神经功能Frankel分级、骨融合时间及Cobb角矫正率。结果:后路组手术时间(174.4±9.9)min、术中出血量(885.0±95.7)ml、术后出血量(103.2±11.5)ml、术后住院时间(15.1±0.7)d;前路组手术时间(229.5±15.2)min、术中出血量(1 326.0±113.5)ml、术后出血量(153.2±16.7)ml、术后住院时间(19.0±0.8)d,两组间的差异均具有统计学意义。并发症发生率前路组为16.3%,后路组为9.3%,差异有统计学意义。后路组的Cobb角矫正率为(73.4±3.2)%,优于前路组的(62.3±2.5)%。两组间的植骨融合时间差异无统计学意义。术后VAS、ODI评分及神经功能分级均较术前明显改善,但两组比较差异无统计学意义。结论:Ⅰ期前路或后路手术均能有效治疗胸腰段脊柱结核,但是后路手术相对于前路手术,创伤更小,畸形矫正效果更好。Objective ：To compare the outcomes of surgical operation by posterior or anterior approach only for thora- columbar tuberculosis. Methods：The clinical data of 97 patients with thoracolumbar tuberculosis underwent debridement and internal fixation from January 2005 to December 2014 were retrospectively analyzed. The study included 59 males and 38 fe- males, with a mean age of 53.7 years ranged from 20 to 68 years. The course of disease was from 1 to 13 months with an average of （6.9Э2.3） months. Among these patients,43 cases were treated through one-stage anterior approach （anterior approach group） and 54 cases were treated through posterior approach （posterior approach group）. The clinical data and imaging data of 97 cases were analyzed, including the operation time, intraoperative and postoperative blood loss, postoperative hospitalization time, complications, visual analogue scale （VAS）, Oswestry Disability Index （ODI）, Frankle grade, bone fusion time, and cor- rective rate of Cobb angle. Results：Operation time,intraoperative and postoperative blood loss,postoperative hospitalization time, complication rate, and corrective rate of Cobb angle were （174.4±9.9） min, （885.0±95.7） ml, （103.2±11.5 ） ml, （15.1±0.7） d ,9.3%, （73.4±3.2）% in posterior group respectively ,while in anterior approach group were（229.5±15.2） min, （ 1326.0± 113.5 ） ml, （ 153.2± 16.7） ml, （ 19.0±0.8 ） d, 16.3%, （62.3 ±2.5 ） %, respectively, and there was significant difference between two groups. There was no significant difference in graft bone fusion between two groups. Postoperative VAS, ODI, Frankel grade of all patients were obviously improved, but there was no significant difference between two groups. Conclusion： Thoracolum- bar tuberculosis could be cured by one-stage anterior or posterior approach with debridement,bone grafting and internal fixa- tion, but posterior approach has advantages of less trauma and better deformity correction.

关 键 词：结核 脊柱 手术入路 内固定术 

分 类 号：R529.2[医药卫生—内科学]