小切口保留肋骨技术在胸椎结核前路手术中的应用  

The application of small incision rib preservation technique in anterioRthoracic spinal tuberculosis

作　　者：刘昌昊 杨宗强[2] 朱禧[2] 施建党[2] 张旭 牛宁奎[2] 郑建平[2] LIU Chang-hao;YANG Zong-qiang;ZHU Xi;SHI Jian-dang;ZHANG Xu;NIU Ning-kui;ZHENG Jian-ping(School of Clinical Medicine,Ningxia Medical University,Yinchuan,Ningxia 750000,China;Dept of Spine Orthopaedics,the General Hospital of Ningxia Medical University,Yinchuan,Ningxia 750000,China)

机构地区：[1]宁夏医科大学临床医学院,宁夏银川750000 [2]宁夏医科大学总医院脊柱骨科,宁夏银川750000

出　　处：《临床骨科杂志》2022年第2期179-183,共5页Journal of Clinical Orthopaedics

基　　金：国家自然科学基金(编号:81760399)。

摘　　要：目的探讨小切口保留肋骨技术在胸椎结核前路手术中的临床疗效。方法采用后前联合入路手术方式治疗40例胸椎结核患者,根据前路手术入路方式不同分为A组(采用小切口保留肋骨手术治疗,18例)和B组(传统切口手术治疗,22例)。记录两组手术情况和手术前后红细胞沉降率(ESR)、C-反应蛋白(CRP)变化趋势,比较两组术后1 d及末次随访时Cobb角、疼痛VAS评分以及术后并发症发生率。结果患者均获得随访,时间7~24个月。前路切口长度、手术时间、术中出血量及住院时间A组均短(少)于B组(P<0.05)。ESR、CRP两组术后各时间点均较术前降低(P<0.05),CRP术后3个月B组低于A组(P<0.05),ESR、CRP术后6个月、末次随访时两组比较差异均无统计学意义(P>0.05)。Cobb角术后1 d、末次随访时两组比较差异均无统计学意义(P>0.05)。疼痛VAS评分术后1 d A组低于B组(P<0.05),末次随访时两组比较差异无统计学意义(P>0.05)。两组术后并发症发生率A组明显低于B组(P<0.05)。结论与传统手术相比,小切口保留肋骨技术在胸椎结核前路手术中同样可获得良好疗效,并有减轻入路创伤、减少术后并发症的优点。Objective To investigate the clinical effect of small incision rib preservation technique in anterioRthoracic spinal tuberculosis surgery.Methods The 40 patients with thoracic spinal tuberculosis were treated by posterior-anterioRcombined approaches.According to the different approaches of anterioRapproach,they were divided into group A(rib preservation operation with small incision,18 cases)and group B(traditional incision,22 cases).The operation situation and the change tendency of erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)before and afteRsurgery were recorded in the two groups.Cobb angle,pain VAS and incidence rate of postoperative complications were compared between the two groups at postoperative 1 d and the last follow-up.Results All patients were followed up foR7~24 months.The anterioRincision length,operation time,intraoperative blood loss and hospital stay in group A were all shorter(less)than those in group B(P<0.05).At each time-point afteRsurgery,ESRand CRP were both loweRthan those before surgery(P<0.05),CRP in group B was loweRthan that in group A at 3 months postoperation(P<0.05),and ESRand CRP had no significant differences between the two groups at 6 months afteRsurgery and the last follow-up(P>0.05).There were no significant differences in Cobb angles between the two groups at postoperative 1 d and the last follow-up(P>0.05).At 1 d postoperation,pain VAS in group A was loweRthan that in the group B(P<0.05),and there was no significant difference between the two groups at the last follow-up(P>0.05).The incidence rate of postoperative complications in group A was significantly loweRthan that in group B(P<0.05).Conclusions Compared with traditional surgery,the rib preservation technique with small incision can also obtain good efficacy in anterioRthoracic spinal tuberculosis surgery,and which has the advantages of alleviating the approach trauma,reducing postoperative complications and shortening the recovery time of patients.

关 键 词：胸椎结核 改良手术 前入路 

分 类 号：R529.2[医药卫生—内科学] R687.3[医药卫生—临床医学]