一期后路病灶清除植骨融合内固定治疗胸腰椎结核

One-stage posterior debridement，bone graft and instrumentation for thoracolumbar tuberculosis

中文关键词:  脊柱结核  病灶清除  内固定  植骨  后路

英文关键词:Spine tuberculosis  Debridement  Internal fixation  Posterior approach

中文摘要:

  【摘要】 目的：探讨一期后路病灶清除植骨融合内固定治疗胸腰椎结核的可行性及疗效，并与前后路联合手术相比较。方法：回顾分析2006年1月至2008年10月收治的67例胸腰椎结核患者，其中后路手术组（A组）38例，行一期后路病灶清除、植骨融合、内固定术；前后路联合手术组（B组）29例，行一期前路病灶清除、植骨融合、后路内固定术。评价两组患者的手术时间、术中出血量、住院天数及手术前后的ASIA分级、Cobb角、血沉变化情况，并进行比较分析。结果：A组手术时间平均为160.4±20.5min，术中出血平均为760.7±146.2ml，住院天数平均为13.6±3.2d；B组分别为231.4±27.3min、1023.8±197.9ml和18.7±3.6d，两组间比较有显著性差异（P＜0.01）。随访7～34个月，平均16.8个月。两组均无严重并发症发生，A组1例出现结核脓肿复发，经前路脓肿清除后治愈。末次随访时，所有植骨均获骨性融合，无内固定松动及断裂出现。神经功能ASIA分级A组中术前有障碍者25例，术后24例改善明显；B组中术前有障碍者18例，术后15例改善明显。Cobb角A组由术前的32.5°±13.2°减小到术后的15.3°±8.2°；B组由术前的35.2°±14.3°，减小到术后的15.8°±8.7°。ESR值A组由术前的36.2±5.6mm/h，减小到术后的20.5±4.3mm/h；B组由术前的38.5±6.1mm/h，减小到术后的19.6±4.1mm/h。两组的ASIA、Cobb角及ESR值变化程度比较无明显差异（P>0.05）。结论：一期后路病灶清除、植骨融合、内固定术治疗胸腰椎结核与前后路联合术式均可获得较好的治疗效果，但后路术式手术时间短、出血少、住院时间短。

英文摘要:

  【Abstract】 Objective：To investigate the clinical efficacy and outcome of one-stage posterior debridement，bone graft and instrumentation for thoracolumbar tuberculosis and compare it with combined anterior and posterior approach.Method：A total of 67 cases with thoracolumbar tuberculosis between January 2006 and October 2008 were reviewed retrospectively，of these，39 cases underwent one-stage posterior debridement，bone graft and instrumentation（group A） while another 29 cases experienced anterior debridement and bone graft plus posterior instrumentation（group B）.The operation time，intraoperative blood loss，hospitalization，ESR，ASIA grade and Cobb′s angle before and after surgery between each group were reviewed and compared respectively.Result：In group A，the average operation time was 160.4±20.5min，the average blood loss was 760.7±146.2ml and the average hospitalization was 13.6±3.2d.While in group B，the average operation time was 231.4±27.3min，the average blood loss was 1023.8±197.9ml and the average hospitalization was 18.7±3.6d which showed significant difference between two groups（P＜0.01）.All cases were followed up for 7-34 months（average 16.8 months）.During follow-up，no severe complication was found in both of the two groups.1 case of group A was found tuberculosis of psoas abscess recurrence，and then was cured by the anterior focus clearance.At final follow-up，all cases had evidence of solid bony fusion without any instrument failure.24/25 cases in group A with preoperative neurological deficit improved significantly while 15/18 cases in group B with preoperative neurological deficit improved.The average Cobb′s angle in group A decreased from 32.5°±13.2° preoperatively to 15.3°±8.2° postoperatively and that in group B decreased from 35.2°±14.3° preoperatively to 15.8°±8.7° postoperatively.The value of ESR in group A decreased from 36.2±5.6mm/h preoperatively to 20.5±4.3mm/h postoperatively and that in group B decreased from 38.5±6.1mm/h preoperatively to 19.6±4.1mm/h postoperatively.No significant difference was noted with respect to ASIA grade，Cobb′s angle and ESR between two groups（P>0.05）.Conclusion：Either one-stage posterior debridement，bone graft and instrumentation or combined anterior and posterior surgery can ensure good clinical outcome for thoracolumbar tuberculosis，however，posterior approach have the advantages of less operation time，less blood loss and shortened hospitalization.