单纯前路或后路病灶清除植骨融合内固定术治疗腰椎结核的疗效对比

Compare study on the effect of posterior only approach and anterior only approach surgery for lumbar tuberculosis in adults

中文关键词:  脊柱  前路融合术  结核  腰椎

英文关键词:Anterior spinal fusion  Spinal  Tuberculosis  Lumbar vertebrae

中文摘要:

  【摘要】 目的：对比分析一期单纯前路或后路病灶清除内固定植骨融合术治疗腰椎结核的疗效及其优势。方法：回顾性分析2002年1月~2012年1月我院收治的216例腰椎结核患者的资料，选择单纯前路或后路手术治疗且随访超过3年的单节段腰椎结核患者纳入研究。共纳入117例，其中前入路一期行病灶清除、植骨融合内固定术者为前路组（45例）；后入路一期行病灶清除、植骨融合内固定术者为后路组（72例）。对比两组间的创伤指标（手术时间、出血量、住院时间、并发症）、影像学指标（植骨融合时间、后凸Cobb角、矫正率）及临床疗效指标[Oswestry功能障碍指数（ODI）、疼痛视觉模拟评分（VAS）及改善率]，并进行统计学分析。结果：前路组的手术时间（207.9±30.9min）、术中出血量（409.5±107.9ml）、住院时间（11.5±1.2d）均低于后路组（287.5±30.7min、835.7±161.9ml、19.2±1.4d），差异有统计学意义（P＜0.05）；并发症发生率前路组为15.56%（7/45），后路组为13.89%（10/72），两组间差异无统计学意义（P＞0.05）。骨性融合时间前路组为7.6±1.2个月、后路组为7.5±1.2个月，两组间比较差异无统计学意义（P＞0.05）。末次随访时，后凸Cobb角前路组为12.37°±1.58°，较术前（27.66°±6.83°）明显改善，改善率为（55.28±5.45）％；后路组为7.91°±1.34°，较术前（28.84°±8.32°）明显改善，改善率为（72.57±3.17）％，后路组在改善后凸畸形方面优于前路组（P＜0.05）。末次随访时，前路组和后路组ODI分别为（10.10±1.38）％和（7.90±1.84）％，改善率分别为（72.11±2.12）％和（78.55±1.57）％，两组间比较差异无统计学意义（P＞0.05）；VAS评分分别为1.21±0.67分和2.31±0.83分，改善率分别为（85.98±5.45）％和（72.57±5.04）％，两组间差异有统计学意义（P＜0.05）。结论：两种手术方式治疗腰椎结核均可获得良好的临床疗效，前入路行病灶清除内固定植骨融合术，手术时间短、出血少、住院时间缩短，且不破坏正常的后路韧带复合体（PLC），术后腰背痛发生率低。

英文摘要:

  【Abstract】 Objectives: To compare and analyze the efficacy and advantages of anterior approach and posterior approach in the treatment of lumbar tuberculosis. Methods: Total 216 patients with lumbar tuberculosis from January 2002 to January 2012 were retrospectively analyzed, and 117 Patients with a single anterior or posterior surgical treatment and the follow-up no less than 3 years were enrolled. Among them, 45 patients underwent anterior approach only surgery(anterior approach group), and 72 patients underwent posterior approach only surgery(posterior approach group). The trauma indexes(operation time, bleeding volume, hospitalization time and complications), imaging indexes(bone fusion time, segment kyphosis and correction rate) and clinical efficacy evaluation indexes(Oswestry disability index, pain visual analogue scale and improvement rate) between the two groups were compared and analyzed statistically. Results: The operation time of the anterior approach group was 207.9±30.9min, the intraoperative blood loss was 409.5±107.9ml and the length of stay was 11.5±1.2 days, all of them were lower than those of the posterior approach group(287.5±30.7min, 835.7±161.9ml, 19.20±1.42d), the difference was statistically significant(P<0.05). The complication rate of the anterior approach group was 15.56%(7/45) and the posterior approach group was 13.89%(10/72). There was no significant difference between the two groups(P>0.05). The bone fusion time of the anterior approach group was 7.6±1.2 months and the posterior approach group was 7.5±1.2 months. There was no significant difference between the two groups(P>0.05). At the final follow-up, the kyphosis Cobb angle of the anterior approach group was 12.37°±1.58°, the improvement rate was (55.28±5.45)% compared to the preoperative angle(27.66°±6.83°). The mean postoperative kyphosis Cobb angle of the posterior approach group was 7.91°±1.34°, which was significantly higher than that of the preoperative one(28.84°±8.32°), and the improvement rate was (72.57±3.17)%. The posterior group was better than the anterior group in the improvement of the kyphosis(P<0.05). The ODI in the anterior approach group and posterior approach group was (10.10±1.38)% and (7.90±1.84)% at the final follow-up, and the improvement rate was (72.11±2.12)% and (78.55±1.57)% respectively. There was no significant difference between the two groups(P>0.05). The VAS scores were 1.21±0.67 and 2.31±0.83, and the improvement rates were (85.98±5.45)% and (72.57±5.04)% respectively, there were significant differences between the two groups(P<0.05). Conclusions: Both two approaches of surgical treatment of lumbar tuberculosis can get a good clinical efficacy, but the anterior approach has a shorter operation time, less blood loss, shorter hospital stay, lower incidence of postoperative low back pain owning to the protection of the normal posterior ligament complex(PLC).