前后路手术治疗腰骶椎结核的临床对比研究  

Clinical comparison of anterior and posterior approach in the treatment of lumbosacral tuberculosis

作　　者：宋晋刚[1] 崔易坤[1] 赵兵[1] 尹振宇[1] 羊刚毅[1] 黄海峰[1] SONG Jin-gang;CUI Yi-kun;ZHAO Bing;YIN Zhen-yu;YANG Gang-yi;HUANG Hai-feng(Department of Spinal Surgery,Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]四川省绵阳市中心医院脊柱外科,四川绵阳621000

出　　处：《颈腰痛杂志》2020年第6期688-692,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的探讨经后路一期手术清除病灶、异体骨植入、椎弓根钉内固定治疗腰骶椎结核的可行性、有效性及优点。方法选择2014年1月~2018年6月于本院收治的腰骶椎结核患者60例,随机分为两组,A组采用传统的经侧前方清除病灶、异体植骨融合内固定治疗;B组采用一期经后路清除结核病灶、异体骨植骨融合、椎弓根内固定治疗。术后1、3、6、12个月定期随访复查:(1)一般项目,包括手术时间、出血量、切口、术后下床时间、住院时间;(2)血液生化指标,包括血常规、血沉、C-反应蛋白、肝肾功能;(3)影像学指标,评价患者的后凸Cobb角度矫正度、植骨融合情况及内固定位置;(4)临床症状好转情况,利用患者术前、术后的腰腿痛VAS评分、Barthel指数进行评价。结果所有患者随访12~18个月,平均16个月。所有患者术后脊柱结核病症控制良好,1年后全部骨性融合,均有效矫正后凸畸形,临床症状明显好转,两组数据无显著性差异(P>0.05)。但B组的手术时间、出血量、切口长度、术后下床时间及住院时间优于A组(P<0.05)。结论一期后路手术治疗腰骶椎结核,操作相对简便、创伤较小,异体骨植骨量充分,椎弓根内固定有效可靠,融合率高,临床效果满意。Objective To explore the feasibility,effectiveness and advantages of one-stage posterior surgery to clear the lesion,allogeneic bone implantation and pedicle screw internal fixation in the treatment of lumbosacral tuberculosis.Methods From January 2014 to June 2018,a comparative study was conducted in 60 patients who needed surgical treatment for lumbar sacral vertebra tuberculosis in our department.Patients were randomly divided into two groups.Group A was treated with traditional translateral anterior clearance of lesions and internal fixation with bone graft fusion.Group B was treated with one-stage retrograde tuberculosis clearance,allogeneic bone grafting and fusion,and pedicle internal fixation.Regular follow-up was performed at 1,3,6 and 12 months after the operation:(1)General items,including operation time,blood loss,incision,postoperative time of getting out of bed,and length of stay.(2)Blood biochemical indicators,including blood routine,erythrocyte sedimentation rate,C-reactive protein,liver and kidney function.(3)Imaging indicators were used to evaluate the kyphosis Cobb angle correction,bone graft fusion and internal fixation position of the patients.(4)VAS score of lumbar and leg pain and Barthel index were used to evaluate the improvement of patients'clinical symptoms before and after operation.Results All cases were followed up for 12-18 months,with an average of 16 months.All patients had good control of spinal tuberculosis,and 1 year later,all patients had bone fusion,which effectively corrected kyphosis,and the clinical symptoms were significantly improved.There was no significant difference between the two groups(P>0.05).However,the operation time,blood loss,incision length,postoperative time of getting out of bed and hospital stay in group B were better than those in group A(P<0.05).Conclusion One-stage posterior surgery in the treatment of lumbosacral tuberculosis is relatively simple and less invasive,with sufficient allograft bone mass,effective and reliable pedicle internal fixation,high

关 键 词：脊柱结核 后路 腰骶椎 异体骨 融合 

分 类 号：R529.2[医药卫生—内科学]