长节段皮质骨轨迹螺钉固定胸腰椎结核临床疗效分析:2年随访比较  

Clinical analysis of long-term cortical bone track screw fixation for thoracolumbar tuberculosis:a 2-year follow-up comparison

作　　者：沙西卡·那孜尔汗 张树文 郭瑞[1] 孙治国[1] 王浩[1] Shaxika Nazierhan;Zhang Shuwen;Guo Rui;Sun Zhiguo;Wang Hao(Peo-ple's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院骨科,乌鲁木齐830000

出　　处：《中华老年骨科与康复电子杂志》2023年第2期81-87,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：新疆维吾尔自治区地区自然科学基金面上项目(2018D01C135)。

摘　　要：目的探究长节段皮质骨轨迹螺钉固定胸腰椎结核的长期临床疗效。方法回顾性收集2015年6月至2019年6月接受后路受累椎体固定联合前路清创术和植骨治疗的76例胸腰椎结核患者资料,根据手术方式不同分为CBT组及PS组(CBT组42例,PS组34例)。观察并比较两组术中出血量、手术时间、切口疼痛和腿部疼痛的视觉模拟评分(VAS)、植骨融合和并发症、术前、术后矢状位Cobb角度、术后日本骨科协会(JOA)评分的各项指标。结果76例患者全部获得随访,CBT组随访时间(31.8±7.8)月,PS组(30.5±7.3)月。CBT组男23例,女19例,平均年龄(39.8±12.2)岁;PS组男19例,女15例,平均年龄(43.5±11.3)岁。CBT组出血量为(172.0±70.7)ml,少于PS组的(243.0±75.4)ml,住院时间为(8.9±2.9)d,少于PS组的[(11.4±1.7)d](均P<0.05)。两组术前及术后3 d、7 d、3个月及末次随访时的腰痛VAS评分显著优于术前(P<0.01),术后3 d、7 d CBT组明显优于PS组(P<0.05),术后3个月及末次随访时差异无统计学意义。两组术前及术后1、3、6个月及末次随访时JOA评分均明显优于术前(P<0.01),组间比较差异无统计学意义,术后及末次随访时矢状位Cobb角度CBT组优于PS组(术后:F=3.541,P=0.041;末次随访:F=2.341,P=0.046),骨融合时间组间比较差异无统计学意义。结论两组术后均达到矫正后凸畸形的效果及明显提高患者生活质量,CBT螺钉有保留脊柱的运动单元的优势。Objective To investigate the long-term clinical effect of long segment cortical bone track screw fixation for thoracolumbar tuberculosis.Methods The data of 76 patients with thoracolumbar tuber-culosis who received posterior vertebral body fixation combined with anterior debridement and bone grafting from June 2015 to June 2019 were retrospectively collected.They were divided into CBT group and PS group according to different surgical methods(42 cases in CBT group and 34 cases in PS group).The intraop-erative bleeding volume,operation time,visual analogue score(VAS)of incision pain and leg pain,bone graft fusion and complications,preoperative and postoperative Cobb angle in sagittal position,and postopera-tive JOA score of the two groups were observed and compared.Results All 76 patients were followed up for(31.8±7.8)months in CBT group and(30.5±7.3)months in PS group.In CBT group,there were 23 males and 19 females,with an average age of(39.8±12.2)years;There were 19 males and 15 females in PS group,with an average age of(43.5±11.3).The bleeding volume(172.0±70.7 ml),fixed segment(243.0±75.4 ml)and hospital stay(8.9±2.9 days)in CBT group were significantly lower than those in PS group(11.4±1.7 days)(all P<0.05).The VAS score of low back pain in the two groups was significantly better than that be-fore operation and at the 3rd,7th,3rd and last follow-up.The JOA scores of the two groups were significant-ly better than those before operation and 1,3,6 months after operation and at the last follow-up.The sagittal Cobb angle in the CBT group was better than that in the PS group at postoperative and final follow-up(post-operative:F=3.541,P=0.041;final follow-up:F=2.341,P=0.046).Conclusion Both groups have achieved the effect of correcting kyphosis deformity and significantly improve the quality of life of patients after operation.CBT screw has the advantage of preserving the motor unit of the spine.

关 键 词：骨结核 胸腰椎 皮质骨螺钉 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]