侧前方手术入路治疗胸腰段结核的疗效  

Efficacy of combined anterior and posterior approach and lateral anterior approach in the treatment of thoracolumbar tuberculosis

作　　者：刘波[1] 褚言琛[2] 侯庆先[2] 杨文玖[2] 王志杰[2] Liu Bo;Chu Yanchen;Hou Qingxian;Yang Wenjiu;Wang Zhijie(Department of Surgery,Medical College,Qingdao University,Qingdao 266071,China;Department of Spine Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学医学院外科学系,266071 [2]青岛大学附属医院脊柱外科,266555

出　　处：《中华实验外科杂志》2020年第6期1036-1040,共5页Chinese Journal of Experimental Surgery

基　　金：山东省重点研发计划项目(2018GSF118080);青岛市科技惠民专项课题(19-6-1-16-nsh)。

摘　　要：目的探讨对胸腰段结核患者应用侧前方手术入路的临床治疗效果。方法分析2010年9月至2018年9月于青岛大学附属医院诊断为胸腰段结核并采取手术治疗的临床资料共32例,根据手术方式,将其分为两组,其中17例行前后路联合入路手术为对照组(A组),15例行侧前方手术入路为实验组(B组)。比较两组在手术情况、住院情况、术后并发症,并随访比较两组术前、术后1个月及末次随访时的红细胞沉降率和C反应蛋白(CRP)变化、后凸畸形矫正角度(Cobb角)、日本骨科协会脊髓功能评分(JOA评分)、腰背部疼痛视觉评分(VAS评分)及神经功能改善情况(Frankel分级)。组间比较采用配对样本t检验。结果侧前方组手术时间[A组(285.24±89.21)min比B组(221.56±64.89)min,t=2.281 P<0.05]、术中出血量[A组(644.21±166.65)ml比B组(541.88±101.49)ml,t=2.062,P<0.05)和住院时间[A组(16.78±2.88)d比B组(14.01±2.62)d,t=2.831,P<0.05]均显著低于前后路联合组,差异均有统计学意义。住院费用[A组(6.81±1.62)万元比B组(7.34±1.45)万元,t=-0.970,P>0.05]差异无统计学意义。两组内红细胞沉降率术前与术后1个月比较[A组:t=4.463,P<0.05;B组:t=5.557,P<0.05)、术后1个月与末次随访比较(A组:t=4.899,P<0.05;B组:t=4.418,P<0.05),C反应蛋白术前与术后1个月比较(A组:t=9.486,P<0.05;B组:t=7.525,P<0.05)、术后1个月与末次随访比较(A组:t=6.781,P<0.05;B组:t=4.735,P<0.05)不同时间点比较,差异均有统计学意义,且两次随访均显著低于术前值。组间红细胞沉降率、C反应蛋白比较,各时间点差异均无统计学意义。两组Cobb角术前与末次随访时比较(A组:t=5.401,P<0.05;B组t=5.700,P<0.05)、JOA评分术前与末次随访比较(A组t=-7.541,P<0.05;B组t=-7.913,P<0.05)、VAS评分术前与末次随访比较(A组t=10.027,P<0.05;B组t=10.107,P<0.05),差异均有统计学意义,且末次随访均显著低于术前值。两组间Cobb角、JOA评分、VAS评分,时间点差Objective To study the clinical effect of lateral extracavitary approach for patients with thoracolumbar tuberculosis.Methods The clinical data of 32 thoracolumbar tuberculosis patients who underwent surgery between September 2010 and September 2018 in the Affiliated Hospital of Qingdao University were analyzed.According to the surgery,patients were divided into two groups.There were 17 patients who received combined anterior and posterior approach(control group)and 15 patients who received lateral extracavitary approach(experimental group).Operative data,in-hospital data,postoperative complications were compared between two groups.We also compared the preoperative,postoperative one month,and last follow up outcome of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),Cobb angle,Japanese Orthopaedic Association(JOA)score,VAS score and improvement in neurological function.Paired t test was used for comparison between groups.Results The operative time[control group:(285.24±89.21)min;experimental group:(221.56±64.89)min,t=2.281,P<0.05],blood loss[control group:(644.21±166.65)ml;experimental group:(541.88±101.49)ml,t=2.062,P<0.05]and hospital stay(control group:16.78±2.88;experimental group B:14.01±2.62,t=2.831,P<0.05)in experimental group were significantly reduced as compared with those in control group.There was no significant difference in hospitalization expense between two groups.In both groups,significant differences were observed in ESR and CRP before and one month postoperation(for ESR,control group:t=4.463,P<0.05;experimental group:t=5.557,P<0.05.for CRP,control group:t=9.486,P<0.05;experimental group:t=7.525,P<0.05),and between postoperative one month and last follow-up(for ESR,control group:t=4.899,P<0.05;experimental group:t=4.418,P<0.05.for CRP,control group:t=6.781,P<0.05;experimental group:t=4.735,P<0.05).There was no significant difference in ESR and CRP between two groups at each time point.In both groups,the Cobb angle(control group:t=5.401,P<0.05;experimental group:t=5.700,P<0.05),J

关 键 词：胸腰段 脊柱结核 侧前方入路 前后路联合入路 疗效 

分 类 号：R687[医药卫生—骨科学]