单纯后路病灶清除颗粒植骨内固定与后前路联合治疗腰椎结核的疗效比较  

Efficacy comparison between simple posterior lesion removal particle bone graft internal fixation surgery and combined posterior and anterior approaches for lumbar tuberculosis

作　　者：刘树仁 付琳[1] 景艳色 贾晨光[1] 赵桂松 李卓[1] Liu Shuren;Fu Lin;Jing Yanse;Jia Chenguang;Zhao Guisong;Li Zhuo(Department of Orthopedics,Hebei Chest Hospital,Hebei Province,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院骨一科,石家庄050041

出　　处：《疑难病杂志》2024年第6期697-702,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究课题计划(20191021)。

摘　　要：目的探讨单纯后路病灶清除颗粒植骨内固定术治疗腰椎结核的疗效及安全性。方法回顾性分析河北省胸科医院2020年5月—2022年8月接受腰椎结核后路及后前路手术的患者42例,根据手术方式分为单纯后路组24例和后前路组18例。比较2组患者手术时间、术中出血量及术后卧床时间;检测ESR、CRP等炎性指标的变化;使用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估腰部疼痛及功能恢复情况;测量术后Cobb角矫正度数与随访1年丢失度数,记录术后融合时间;应用Bridwell植骨融合标准及CT骨融合标准评估植骨融合情况。结果与后前路组比较,单纯后路组手术时间缩短(t/P=5.995/<0.001),术中出血量减少(t/P=2.134/0.039),术后卧床时间缩短(t/P=5.835/<0.001)。与术前比较,2组患者术后6个月ESR、CRP降低,差异均有统计学意义(P<0.01);随访1年VAS、ODI评分均降低,差异有显著统计学意义(P<0.01),而2组之间比较差异无统计学意义(P>0.05)。2组患者术后Cobb角纠正度数、术后1年丢失度数及术后融合时间比较差异无统计学意义(P>0.05)。根据Bridwell融合标准和CT骨融合标准,2组随访1年的植骨融合比较,差异无明显统计学意义(P>0.05)。结论单纯后路与后前路联合手术治疗腰椎结核均可获得满意疗效。单纯后路病灶清除颗粒植骨内固定手术治疗腰椎结核取得了良好的临床疗效且安全可行,具有手术时间短、出血少、创伤小的优点。Objective To compare the curative effect difference between the simple posterior approach and the combined posterior and anterior approach for the treatment of lumbar tuberculosis,to explore the feasibility of the simple posterior lesion clearance particle bone graft internal fixation surgery.Methods A retrospective analysis was performed for 42 patients who underwent simple posterior or combined posterior and anterior surgery for lumbar tuberculosis in Hebei Chest Hospital from May 2020 to August 2022,and were divided into the simple posterior group and combined posterior and anterior group according to the surgical method.There were 24 cases in the simple posterior group,including 13 males and 11 females,aged 22-80 years.There were 18 cases in the combined posterior and anterior group,including 10 males and 8 females,aged 17-69 years.The operation time,intraoperative blood loss,postoperative bed rest time,ESR and CRP were compared between the two groups.Low back pain and functional recovery were assessed using the Pain Visual Analogue Scale(VAS)and the Oswestry Dysfunction Index(ODI).The degree of Cobb Angle correction,the degree of loss at 1 year and the postoperative fusion time were compared between the two groups.Bridwell bone fusion criteria and CT bone fusion criteria were used to evaluate bone fusion.Results The operation time of the simple posterior group was lower than that of the combined posterior and anterior group(t/P=5.995/<0.001).The intraoperative blood loss in the posterior group was lower than that in the combined posterior and anterior group(t/P=2.134/0.039).The postoperative bed time in posterior group was lower than that in the combined posterior and anterior approach group(t/P=5.835/<0.001).There were significant differences in ESR and CRP between 2 groups 6 months after operation and before operation(P<0.01).VAS and ODI scores before surgery and 1 year follow-up was compared between the two groups,and there was significant statistical significance(P<0.01).There was no significant differen

关 键 词：腰椎结核 单纯后路 后前路联合颗粒植骨 临床疗效 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]