植骨融合内固定术联合前后不同入路病灶清除术治疗胸腰椎结核患者的临床价值对比分析  

Comparative analysis of the clinical value of bone grafting and internal fixation combined with different approaches before and after debridement for the treatment of thoracolumbar tuberculosis

作　　者：赵兵[1] 黄海锋[1] 羊刚毅[1] 宋晋刚[1] 尹振宇[1] ZHAO Bing;HUANG Hai-feng;YANG Gang-yi(Department of Spinal Surgery,Mianyang Central Hospital,Mianyang Sichuan 621000,China)

机构地区：[1]绵阳市中心医院脊柱外科,四川绵阳621000

出　　处：《临床和实验医学杂志》2022年第18期1985-1988,共4页Journal of Clinical and Experimental Medicine

基　　金：四川省卫计委普及应用项目(编号:2116pj191)。

摘　　要：目的对比分析植骨融合内固定术联合前后不同入路病灶清除术治疗胸腰椎结核患者的临床效果。方法回顾性选取2017年5月至2021年5月绵阳市中心医院收治的胸腰椎结核患者83例,根据治疗方式同分为研究组(植骨融合内固定术联合后入路病灶清除术,n=41)和对照组(植骨融合内固定术联合前入路病灶清除术,n=42)。比较两组患者的手术相关指标、实验室相关指标[C反应蛋白(CRP)、红细胞沉降率(ESR)]、影像学参数(后凸Cobb角)、椎体功能[Oswestry功能障碍指数问卷表(ODI)]、疼痛程度[视觉模拟评分法(VAS)]评分及并发症发生情况。结果研究组患者的手术时间、术中失血量、住院时间为(131.38±14.82)min、(292.64±62.65)mL、(13.16±4.12)d,均明显少于对照组[(162.21±16.49)min、(387.12±72.63)m L、(15.25±3.63)d],差异均有统计学意义(P<0.05)。与手术前相比,两组患者手术后CRP、ESR水平均明显降低,后凸Cobb角均明显减小,差异均有统计学意义(P<0.05),两组患者手术后CRP、ESR、后凸Cobb角水平比较,差异均无统计学意义(P>0.05)。研究组患者手术后ODI评分、VAS评分为(12.51±2.81)、(1.37±0.59)分,均明显低于对照组[(18.73±3.14)、(2.52±0.63)分],并发症发生率为4.88%,明显低于对照组(17.50%),差异均有统计学意义(P<0.05)。结论采取植骨融合内固定术联合后入路病灶清除术治疗胸腰椎结核能明显缩短手术时间及住院时间,减少术中失血量,改善患者椎体功能,缓解疼痛感,且具有一定的安全性。Objective To compare and analyze the clinical effects of bone grafting and internal fixation combined with different approaches before and after debridement for the treatment of thoracolumbar tuberculosis.Methods A total of 83 patients with thoracolumbar tuberculosis admitted to Mianyang Central Hospital from May 2017 to May 2021 were retrospectively selected,according to the different treatment methods,they were divided into study group(bone graft fusion internal fixation combined with posterior approach lesion removal,n=41)and control group(bone graft fusion internal fixation combined with anterior approach lesion removal,n=42).Operation related indicators,laboratory related indicators[C-reactive protein(CRP),Erythrocyte sedimentation rate(ESR)],imaging parameters(Kyphosis Cobb angle),vertebral body function[Oswestry Disability Index questionnaire(ODI)],pain level[visual analogue scale(VAS)]scores and complications were compared between the two groups.Results The operative time,intraoperative blood loss and hospital stay of the patients in the study group were(131.38±14.82)min,(292.64±62.65)m L,(13.16±4.12)d,which were less than those in the control group[(162.21±16.49)min,(387.12±72.63)m L,(15.25±3.63)d],and the differences were statistically significant(P<0.05).Compared with preoperation,the levels of CRP and ESR of patients were decreased in the two groups after operation,while the kyphotic Cobb angle was decreased in all groups,and the differences were statistically significant(P<0.05),there was no significant difference in the levels of CRP,ESR and kyphotic Cobb angle of patients between the two groups after operation(P>0.05).After treatment,the ODI score and VAS score of patients in the study group were(12.51±2.81)points,(1.37±0.59)points,which were lower than those in the control group[(18.73±3.14)points,(2.52±0.63)points],and the complication rate of study group was 4.88%,which was significantly lower than that of control group(17.50%),and the differences were statistically significant(P<0.05)

关 键 词：胸腰椎结核 植骨融合内固定术 入路 病灶清除术 安全性 

分 类 号：R687.3[医药卫生—骨科学]