斜外侧入路联合经皮椎弓根螺钉内固定治疗腰椎结核的疗效分析  

Efficacy analysis of the treatment of lumbar spinal tuberculosis using oblique lateral approach combined with percutaneous pedicle screw fixation

作　　者：李静 郜勇[3] 陈超[3] 李良黎 LI Jing;GAO Yong;CHEN Chao;LI Liangli(Department of Orthopedics,the People’s Hospital of Honghu,Honghu 433299,China;不详)

机构地区：[1]湖北省洪湖市人民医院骨外科,433299 [2]湖北省洪湖市人民医院康复医学科,433299 [3]华中科技大学同济医学院附属协和医院骨外科

出　　处：《临床外科杂志》2025年第3期317-320,共4页Journal of Clinical Surgery

摘　　要：目的分析斜外侧入路联合经皮椎弓根螺钉治疗腰椎结核的总体效果,并评价其与单纯后路病灶清除植骨融合内固定术的疗效差异。方法2020年1月~2022年10月收治的腰椎结核病人29例,按治疗方法不同分为两组,观察组18例,采用斜外侧入路病灶清除植骨融合+后路经皮椎弓根螺钉内固定;对照组11例,采用单纯后路病灶清除植骨融合椎弓根螺钉内固定术。比较两组手术时间与术中出血量,随访记录两组病人结核病灶愈合情况、ASIA分级、椎间植骨融合情况,VAS评分、ODI评分、Cobb角及其并发症,随访12个月。结果两组手术时间和术中出血量比较,差异无统计学意义(P>0.05)。所有病人结核病灶均痊愈,神经功能ASIA分级为E级,椎间植骨融合率均为100%。观察组和对照组术后3天、3个月、12个月VSA评分分别为(3.79±0.57)°和(4.27±0.61)°,(0.95±0.43)°和(1.44±0.42)°,(0.53±0.20)°和(0.76±0.19)°,两组比较差异有统计学意义(P<0.05)。观察组和对照组术后3天、3个月、12个月ODI评分分别为(29.94±2.84)°和(31.36±2.58)°,(8.94±1.98)°和(11.27±2.19)°,(9.28±2.52)°和(12.72±1.90)°,两组比较差异有统计学意义(P<0.05)。观察组和对照组术后3天、3个月、12个月Cobb角分别为(41.82±2.35)°和(41.5±2.72)°,(41.28±1.67)°和(41.18±1.60)°(39.33±3.52)°和(38.46±2.75)°,两组比较差异无统计学意义(P>0.05)。结论两种术式均能促进结核病灶愈合和植骨融合,斜外侧入路联合经皮椎弓根螺钉固定术具有损伤小、功能恢复佳的优点。Objective To assess the efficacy of the oblique lateral approach with percutaneous pedicle screw fixation for treating lumbar spinal tuberculosis and compare it with conventional posterior surgery.Methods A retrospective study analyzed 29 patients treated for lumbar spinal tuberculosis in our hospital from January 2020 to October 2022.They were divided into two groups according to different treatment methods,the observational group(18 case)underwent oblique lateral lesion clearance,bone graft fusion,and posterior percutaneous pedicle screw fixation,while the control group(11 case)received conventional posterior lesion clearance,bone graft fusion,and internal fixation surgery.The operative time and intraoperative blood loss were compared between the two groups.Operation time and intraoperative blood loss were compared between the two groups,the healing of tuberculosis foci,ASIA grade,intervertebral bone graft fusion,VAS score,ODI score,Cobb Angle and complications were recorded in the two groups,follow-up was 12 months.Results There was no statistically significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).All patients’tuberculosis foci healed,and the neurological function ASIA classification was E level,with an intervertebral bone graft fusion rate of 100%.The VAS scores of the observation group and the control group at 3 days,3 months,and 12 months after surgery were(3.79±0.57)°vs(4.27±0.61)°,(0.95±0.43)°vs(1.44±0.42)°,(0.53±0.20)°vs(0.76±0.19)°,respectively,and the difference between the two groups was statistically significant(P<0.05).The ODI scores of the observation group and the control group at 3 days,3 months,and 12 months after surgery were(29.94±2.84)°vs(31.36±2.58)°,(8.94±1.98)°vs(11.27±2.19)°,(9.28±2.52)°vs(12.72±1.90)°,respectively,and the difference between the two groups was statistically significant(P<0.05).The Cobb angles of the observation group and the control group at 3 days,3 months,and 12 months after surgery were(41.8

关 键 词：斜外侧入路 经皮椎弓根螺钉 腰椎结核 病灶清除 植骨融合 

分 类 号：R68[医药卫生—骨科学]