前路与后路术式治疗单节段腰椎结核的比较  

Anterior versus posterior approach surgical management for single segment lumbar spinal tuberculosis

作　　者：徐用亿[1] 季峰[1] 王守国[1] 孙进[1] 岳海涛[1] 唐洪辉[1] XU Yong-yi,JI Feng,WANG Shou-guo,SUN Jin,YUE Hai-tao,TANG Hong-hui(The First Peoples Hospital of Huai＇an Affiliated to Nanjing Medical University, Huai＇an 223300, Chin)

机构地区：[1]南京医科大学附属淮安第一医院,223300

出　　处：《中国矫形外科杂志》2018年第9期792-797,共6页Orthopedic Journal of China

摘　　要：[目的]分析比较一期前路病灶清除植骨内固定术和一期后路病灶清除植骨内固定术治疗单节段腰椎结核的临床效果,探讨单节段腰椎结核手术方式的选择。[方法]回顾分析2008年6月~2015年6月在本科手术治疗的40例单节段腰椎结核患者。按手术入路分为两组:前路组18例,行前路一期病灶清除植骨内固定术;后路组22例,行经后路一期病灶清除植骨内固定术。采用腰痛VAS、JOA评分、节段后凸Cobb角和其他临床指标评估治疗效果。[结果]前路组与后路组在手术时间上差异无统计学意义[(202.50±40.95)min vs(181.14±46.88)min,P>0.05],在失血量上差异无统计学意义[(627.83±261.87)ml vs(570.52±250.09)ml,P>0.05]。40例均获得24~36个月的随访,所有患者在末次随访时病灶均获得骨性融合。与术前相比,术后和末次随访时两组的ESR、CRP、腰痛VAS评分和节段后凸Cobb角均显著减小,差异有统计学意义(P<0.05),而JOA评分显著增加,差异有统计学意义(P<0.05)。末次随访时,两组之间的ESR、CRP、腰痛VAS评分和JOA评分的差异均无统计学意义(P>0.05),但前路组的后凸矫正丢失角度显著大于后路组,差异有统计学意义[(5.28±2.40)°vs(1.91±1.60)°,P<0.05]。此外,前路组总并发症发生率明显高于后路组,差异有统计学意义[44.44%(8/18)vs 13.64%(3/22),P<0.05]。[结论]在标准抗结核化疗基础上一期前路病灶清除内固定术与后路病灶清除内固定术治疗单节段腰椎结核可取得同样的满意疗效,但后路手术相比前路手术并发症更少,后凸矫正丢失更少。[Objective] To compare the clinical and radiological outcomes of anterior versus posterior surgical debridement combined with instrumented fusion for single segment lumbar spinal tuberculosis. [Methods] From June 2008 to June 2015, 40 patients underwent surgical treatment in our department for single segment lumbar spinal tuberculosis. In term of approaches used, 18 patients had one-stage debridement of tuberculosis and instrumented lumbar fusion performed through the anterior approach（the anterior group）, while the remaining 22 received the single-staged operation through the posterior approach（the posterior group）. The visual analogue scale（VAS） for low back pain, Japanese Orthopaedic Association（JOA） scores, segmental Cobb.s angle and other clinical parameters were applied for evaluation of the consequences. [Results] There were no differences between the two groups in operative time [（202.50±40.95） mins versus（181.14±46.88） mins, P〉0.05] and bleeding [（627.83±261.87） ml versus（570.52±250.09） ml, P〈0.05]. All the 40 patients were followed up for 24 to 36 months. All of them achieved bony fusion of the involved intervertebral space at the latest follow-up. The ESR, CRP, VAS and segmental Cobb.s angle in both group significantly decreased, whereas the JOA scores considerably increased compared the data before operation with those at the latest follow up（P〈0.05）. Despite of no statistical differences in the ESR, CRP, VAS, and JOA score between the two groups（P〉0.05）, the loss of kyphosis correction in the anterior group was significantly greater than the posterior group at the latest follow up [（5.28±2.40）° versus（1.91±1.60）°, P〈0.05]. In addition, the total complication rate in the anterior group was also significantly higher than the posterior group [44.44%（8/18） versus 13.64%（3/22）, P〈0.05]. [Conclusion] On the basis of standardized anti-tuberculosis chemotherapy, both posterior and anterior approach surgeries at one stage achieve simi

关 键 词：腰椎 结核 前路 后路 病灶清除 融合 

分 类 号：R529.2[医药卫生—内科学]