三种术式治疗单节段胸腰段结核比较  

Comparison of three procedures for single-segment thoracolumbar tuberculosis

作　　者：吴昊[1] 韦昌武 邹专 刘云[1] 杨梅[1] 黄秋鸿 梁伟凤 阿布·莫洛 黄先盈 WU Hao;WEI Chang-wu;ZOU Zhuan;LIU Yun;YANG Mei;HUANG Qiu-hong;LIANG Wei-feng;ABU Moro;HUANG Xian-ying(Division of Spine Sur gery,The First Affiliated Hospital,Guangxi Medical University,Nanning 530021,China;The First People's Hospital of Nan ning City,Nanning530021,China)

机构地区：[1]广西医科大学第一附属医院,南宁530021 [2]广西南宁市第一人民医院,南宁530021

出　　处：《中国矫形外科杂志》2020年第9期809-814,共6页Orthopedic Journal of China

基　　金：广西自然科学基金青年科学基金项目(编号:2017GXNSFBA198098);广西再生医学重点实验室开放课题项目(编号:201806桂再重开);广西医科大学教师教学能力发展课题。

摘　　要：[目的]比较前路病灶清除融合固定术(前融合组)、后路钉棒内固定植骨术(后融合组)与后路钉棒内固定非植骨术(后固定组)治疗单节段胸腰段结核的临床疗效。[方法]2010年7月~2017年7月,43例单节段胸腰段结核患者纳入本研究,其中前融合组22例,后融合组12例,后固定组9例,给予相应手术治疗。比较三组围手术期、随访和影像资料。[结果]手术耗时依次为前融合组>后融合组>后固定组(P<0.05);三组间术中出血量、术后引流量和平均住院时间差异均无统计学意义(P>0.05)。前融合组术后出现隔下感染1例,肠梗阻1例,窦道形成2例;后融合组术后出现脑脊液漏2例;后固定组无严重术后并发症。所有患者随访24-108个月,平均(35.65±16.47)个月。随访过程中,三组患者均未出现药物中毒反应、结核病灶复发或再次窦道形成等严重事件。三组患者Frankel指数和VAS评分随时间推移显著改善(P<0.05);相同时间点三组间Frankel指数和VAS评分的差异均无统计学意义(P>0.05)。影像方面,三组术后即刻Cobb角均较术前显著减少(P<0.05),前融合组的矫正效果显著不及后钉棒两组(P<0.05);末次随访时,前融合组矫正角度丢失度数大于后钉棒植骨、后固定组(P<0.05)。所有患者均获得椎间骨性融合,融合时间依次前融合组<后融合组<后固定组(P<0.05)。[结论]三种术式均能有效治疗单节段胸腰段结核,且无论进行植骨与否均可获得椎间骨性融合效果。[Objective]To compare the clinical outcomes of anterior debridement and instrumented fusion(ADIF),posteri or pedicle screw and debridement with bone grafting(PPSB)and posterior pedicle screw and debridement with no bone grafting(PPSNB)for single-segment thoracolumbar(T10~L2)tuberculosis.[Methods]A retrospective study was conducted on 43 patients who underwent surgical treatment for single-segment thoracolumbar tuberculosis in our hospitals from July 2010 to July 2017.In term of procedure performed,22 patients received ADIF,12 patients had PPSB and 9 patients underwent PPSNB.The periop erative,follow-up and radiographic data were compared among the 3 groups.[Results]The time consumed for operation was sig nificantly ranked up-down in the sequence of ADIF>PPSB>PPSNB(P<0.05),despite of no statistical differences among the 3 groups regarding to intraoperative blood loss,postoperative drainage and hospital stay(P>0.05).The ADIF group had infection under the diaphragm in 1 case,intestinal obstruction in 1 and fistulous tract in 2,whereas the PPSB group got leakage of cere brospinal fluid in 2,in which all the complication was cured by corresponding treatment without serious consequence,by con trast,the PPSNB group had no grim complications.During follow-up period ranged from 24 to 108 months with a mean of(35.65±16.47)months,no severe adverse events,such as drug toxicosis,recurrence of tuberculosis lesion and relapse of fistu lous track,happened in anyone of them.The Frankel index and VAS score significantly improved over time in the 3 groups(P<0.05),although no statistically significant differences were noticed in Frankel index and VAS score among the 3 groups at any matching time point(P>0.05).With respect to radio graphic assessment,the kyphotic Cobb's angle significantly decreased postoperatively in all the 3 groups compared with those before operation(P<0.05).The ADIF group was signifi cantly inferior to both PSSB and PSSNB group regarding to kyphotic correction(P<0.05),conversely,the ADIF group had significantly

关 键 词：胸腰椎结核 前路病灶清除融合术 后路病灶清除融合术 后路病灶清除固定术 

分 类 号：R529.2[医药卫生—内科学]