两种术式组合治疗腰骶椎结核的比较  

Comparison of two surgical combinations for lumbosacral tuberculosis

作　　者：沈生军[1] 徐尚胜 任磊[1] 杜鹏[1] 霍永超 赵宇[1] SHEN Sheng-jun;XU Shang-sheng;REN Lei;DU Peng;HUO Yong-chao;ZHAO Yu(Department of Spinal Surgery,Affiliated Hospital,Qinghai University,Xining 810001,China;Department of Orthopedics,The Fourth People's Hospital of Qinghai Province,Xining810000,China)

机构地区：[1]青海大学附属医院脊柱外科,青海西宁810001 [2]青海省第四人民医院骨科,青海西宁810000

出　　处：《中国矫形外科杂志》2023年第17期1573-1578,共6页Orthopedic Journal of China

摘　　要：[目的]比较单纯后路与前后路联合病灶清除固定融合术治疗腰骶椎结核的临床效果。[方法]回顾性分析2010年1月—2019年12月采用个体化手术方式治疗下腰骶椎结核68例患者的临床资料。根据医患沟通结果,36例采用单纯后路手术(后路组),另外32例采用前后联合手术(前后组)。比较两组围手术期、随访和辅助检查结果。[结果]总体并发症率,后路组为7/36(19.4%),前后组为12/32(37.5%)。后路组手术时间[(222.0±34.0)min vs(312.0±40.4)min,P<0.001]、切口总长度[(18.3±3.5)cm vs(34.3±7.0)cm,P<0.001]、术中失血量[(380.0±152.6)ml vs(490.0±209.3)ml,P<0.001]、术中透视次数[(5.5±0.1)次vs(6.1±0.2)次,P<0.001]、下地行走时间[(9.0±0.6)d vs(11.6±0.7)d,P<0.001]、切口愈合等级[甲/乙/丙,(36/0/0)vs(25/7/0),P=0.003]和住院时间[(17.6±3.2)d vs(20.3±4.1)d,P=0.003]均显著优于前后组。所有患者随访12个月以上,两组恢复完全负重活动时间的差异无统计学意义(P<0.05)。随时间推移,两组腰痛VAS和ODI评分均显著降低(P<0.05),JOA评分显著增加(P<0.05)。相应时间点,两组间上述指标的差异均无统计学意义。检验方面,随时间推移,两组ESR均显著降低(P<0.05),相应时间点,两组间ESR的差异无统计学意义(P>0.05)。影像方面,随时间推移,两组患者TB病灶逐步痊愈(P<0.05)。与术前相比,术后6个月和末次随访时,两组患者腰椎前凸角均显著改善(P<0.05)。末次随访时,两组所有患者病变节段均达到骨性融合。相应时间点,两组间病灶影像所见、腰椎前凸角和Bridwell融合分级的差异均无统计学意义(P>0.05)。[结论]对腰骶椎结核应依据具体情况选择手术方式,尽量采用单纯后路手术,以减少手术创伤和并发症风险。[Objective]To compare the clinical outcomes of debridement and instrumented fusion through posterior approach only versus anterior and posterior approaches for lumbosacral tuberculosis(TB).[Methods]A retrospective study was conducted on 68 patients who received individualized surgical treatment for lumbosacral TB from January 2010 to December 2019.Based on doctor-patient communication,36 patients had operation performed through the posterior approach only(PA group),while the other 32 patients were through combined anterior and posterior approaches(the APA group).The documents regarding perioperative period,follow-up and auxiliary examination were compared between the two groups.[Results]The overall complication rate was of 7/36(19.4%)in the PA group,whereas 12/32(37.5%)in the APA groups.In addition,the PA group proved significantly superior to the APA group in terms of operation time[(222.0±34.0)min vs(312.0±40.4)min,P<0.001],total incision length[(18.3±3.5)cm vs(34.3±7.0)cm,P<0.001],intraoperative blood loss[(380.0±152.6)ml vs(490.0±209.3)ml,P<0.001],intraoperative fluoroscopy[(5.5±0.1)times vs(6.1±0.2)times,P<0.001],postoperative ambulation[(9.0±0.6)days vs(11.6±0.7)days,P<0.001],incision healing grade[A/B/C:(36/0/0)vs/(25/7/0),P=0.003)]and hospital stay[(17.6±3.2)days vs(20.3±4.1)days,P=0.003].All patients were followed up for more than 12 months,and there was no significant difference in the time to return to full weight-bearing activities between the two groups(P>0.05).The VAS and ODI scores decreased significantly(P<0.05),whereas the JOA score increased significantly in both groups over time(P<0.05),which were not significantly different between the two groups at any time points accordingly.In term of lab test,ESR decreased significantly over time in both groups(P<0.05),with no significant difference between the two groups at any corresponding time points(P>0.05).Radiographically,the TB lesions in both groups were gradually cured over time(P<0.05),while the lumbar lordosis significantly improved

关 键 词：腰骶椎结核 病灶清除 固定融合 单纯后路 前后路联合 

分 类 号：R529.2[医药卫生—内科学]