腋下经胸入路与后入路病灶清除植骨融合内固定术治疗上胸椎结核的疗效  

The efficacy of axillary and posterior approaches for lesion clearance,bone graft fusion,and internal fixation in the treatment of upper thoracic tuberculosis

作　　者：罗琦山 罗为民 史强 李远红 何友智 许宇霞 Luo Qishan;Luo Weimin;Shi Qiang;Li Yuanhong;He Youzhi;Xu Yuxia(Department of Spine Surgery,Changsha Central Hospital,University of South China,Changsha 410004,China)

机构地区：[1]南华大学附属长沙中心医院脊柱外科,长沙410004

出　　处：《中国医师杂志》2024年第8期1157-1162,共6页Journal of Chinese Physician

基　　金：湖南省卫生健康委科研计划课题(D202304076350);长沙市自科基金项目(kq2014023)。

摘　　要：目的对比腋下经胸入路与后入路病椎清除植骨融合内固定手术治疗上胸椎结核的临床疗效。方法选择南华大学附属长沙中心医院2017年3月至2022年3月收治的55例上胸椎结核患者,根据手术入路的不同分为腋下经胸组和后路组,比较两组患者切口长度、手术时间、术中出血量及术后住院时间。记录两组患者术前和术后1周、3个月、12个月疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分,术前和术后1周、术后3个月血清炎症指标及T淋巴细胞亚群CD4^(+)/CD8^(+)比值,并发症情况。结果腋下经胸组手术切口长度、手术时间和术中出血量明显少于后路组,差异有统计学意义(均P<0.05),但两组患者术后住院时间差异无统计学意义(P>0.05)。两组患者术后1周、术后3个月和12个月时的VAS、ODI评分较术前有明显改善(均P<0.05);且术后1周及术后3个月,腋下经胸组患者的VAS评分明显低于后路组(均P<0.05),术后3个月及12个月的ODI评分明显低于后路组(均P<0.05)。两组患者术后1周的血沉、CRP较术前明显升高(均P<0.05),但术后3个月时血沉及CRP水平基本恢复到正常水平,两组患者术后1周T淋巴细胞亚群CD4^(+)/CD8^(+)比值低于术前水平,但随着治疗的延续,术后3个月时CD4^(+)/CD8^(+)比值明显上升。结论腋下经胸入路和后路均可用于上胸椎结核的手术治疗,但腋下经胸入路具有创伤小、出血少、恢复快的优势。ObjectiveTo compare the clinical efficacy of axillary transthoracic approach and posterior approach in the treatment of upper thoracic tuberculosis with vertebral clearance,bone graft fusion,and internal fixation surgery.MethodsFifty five patients with upper thoracic tuberculosis admitted to Changsha Central Hospital,University of South China from March 2017 to March 2022 were selected and divided into axillary transthoracic group and posterior group according to different surgical approaches.The incision length,surgical time,intraoperative blood loss,and postoperative hospitalization time were compared between the two groups of patients.Two groups of patients were recorded for preoperative and postoperative pain visual analog scale(VAS)scores,Oswestry Disability Index(ODI)scores at 1 week,3 months,and 12 months,preoperative and postoperative serum inflammatory indicators,CD4^(+)/CD8^(+)ratio of T lymphocyte subsets,and complications.ResultsThe incision length,operation time,and intraoperative blood loss in the axillary transthoracic group were significantly less than those in the posterior group,and the differences were statistically significant(all P<0.05).However,there was no statistically significant difference in postoperative hospitalization time between the two groups of patients(P>0.05).The VAS and ODI scores of the two groups of patients showed significant improvement compared to preoperative levels at 1 week,3 months,and 12 months after surgery(all P<0.05);And at 1 week and 3 months after surgery,the VAS scores of patients in the axillary transthoracic group were significantly lower than those in the posterior group(all P<0.05),and the ODI scores at 3 and 12 months after surgery were significantly lower than those in the posterior group(all P<0.05).The erythrocyte sedimentation rate and CRP levels of both groups of patients increased significantly one week after surgery compared with preoperative levels(all P<0.05),but the erythrocyte sedimentation rate and CRP levels basically returned to normal levels

关 键 词：结核 脊柱 胸椎 植骨融合术 手术入路 

分 类 号：R687.3[医药卫生—骨科学] R529.2[医药卫生—外科学]