后路病灶清除椎体间植骨融合术对成人腰椎结核手术指标、影像学参数及Oswestry功能障碍指数评分的影响  

Effects of Simple Posterior Debridement and Lumbar Interbody Fusion on Surgical Indexes,Imaging Parameters and Oswestry Dysfunction Index Score of Adults with Tuberculosis of Lumbar Spine

作　　者：王帅 王连波[2] 董昭良[2] 贾晨光[2] 李卓[2] 高建国[1] WANG Shuai;WANG Lian-bo;DONG Zhao-liang;JIA Chen-guang;LI Zhuo;GAO Jian-guo(Department of Emergency Surgery,Hebei Chest Hospital,Shijiazhuang 050041,China;Department of Orthopedic,Hebei Chest Hospital,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院急诊外科,石家庄050041 [2]河北省胸科医院骨科,石家庄050041

出　　处：《解放军医药杂志》2021年第9期36-39,49,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：2019年度河北省医学科学研究课题计划(20191034)。

摘　　要：目的分析后路病灶清除椎体间植骨融合术对成人腰椎结核的治疗效果。方法选取本院2019年6月—2020年6月收治的成人腰椎结核129例,根据手术入路的不同分为A组(行后路病灶清除椎体间植骨融合术)78例、B组(行前路病灶清除椎体间植骨融合术)51例。比较2组手术指标,术前、术后6个月影像学参数、Oswesty功能障碍指数(ODI)评分及生活质量评分,术前及术后7 d疼痛视觉模拟评分法(VAS)评分,以及并发症发生情况。结果2组手术时间、术中出血量、住院时间、植骨融合时间及术后伤椎高度、Cobb角矫正率比较差异无统计学意义(P>0.05),但A组术后伤椎高度、Cobb角矫正丢失率显著低于B组(P<0.01)。术后7 d,2组ODI评分、VAS评分均较术前降低,且A组上述评分下降更为显著,差异均有统计学意义(P<0.05,P<0.01)。术后6个月,2组躯体疼痛、健康状况、生理功能及生理职能生活质量评分均较术前有所提升,且A组显著高于B组,差异均有统计学意义(P<0.05,P<0.01)。2组并发症总发生率比较差异无统计学意义(P>0.05)。结论后路病灶清除椎体间植骨融合术治疗成人腰椎结核可减少伤椎高度矫正丢失,有效缓解患者疼痛,提高生活质量。Objective To analyze the effectiveness of simple posterior debridement and lumbar interbody fusion in treatment of adults with tuberculosis of lumbar spine.Methods A total of 129 adults with tuberculosis of lumbar spine between June 2019 and June 2020 were selected and divided into group A(n=78,treated with simple posterior debridement and lumbar interbody fusion)and group B(n=51,treated with simple anterior debridement and lumbar interbody fusion).Values of surgical indexes,imaging parameters,Oswesty disability index(ODI)scores and quality of life scores before and after operation for 6 months,visual analogue scale(VAS)scores before and after operation for 7 d,and incidence rate of complications were compared between two groups.Results There were no significant differences in operative duration,intraoperative volume of blood loss,length of hospitalization,time of bone graft fusion,injured vertebral height after operation and correction rate of Cobb angle between two groups(P>0.05),but the injured vertebral height after operation and loss rate of Cobb angle correction in group A were significantly lower than those in group B(P<0.01).After operation for 7 d,ODI and VAS scores were significantly lower than those before operation in two groups,and the decrease of the above scores in group A was more significant(P<0.05,P<0.01).After operation for 6 months,scores of physical pain,health status,physiological function and quality of life were improved compared with those before operation in two groups,and the scores in group A were significantly higher than those in group B(P<0.05,P<0.01).There was no significant difference in the total incidence rate of complications between two groups(P>0.05).Conclusion Simple posterior debridement and lumbar interbody fusion may reduce the loss of vertebral height correction,effectively relieve pain and improve the quality of life in treatment of adults with tuberculosis of lumbar spine.

关 键 词：结核 脊柱 腰椎 脊柱融合术 伤椎高度 COBB角 Oswesty功能障碍指数 生活质量 手术后并发症 

分 类 号：R529.2[医药卫生—内科学]