摘要
目的比较单纯前路与单纯后路病灶清除植骨融合内固定术治疗合并神经损伤胸椎结核的临床疗效。方法回顾性分析自2009-10-2015-11诊治的28例合并神经损伤的胸椎结核,13例行单纯前路病灶清除植骨融合内固定术(前路组),15例行单纯后路病灶清除植骨融合内固定术(后路组)。比较2组手术时间、术中出血量、术后引流时间、植骨融合时间,末次随访时脊髓神经功能Frankel分级,以及疼痛改善程度、后凸畸形矫正程度。结果 28例均获得随访,前路组随访时间平均62.4(26~86)个月,后路组随访时间平均37.3(13~63)个月。前路组与后路组术后1年疼痛VAS评分、后凸Cobb角较术前明显改善,差异有统计学意义(P <0.05)。前路组与后路组手术时间、术中出血量、植骨融合时间、术后脊髓神经功能Frankel分级、后凸畸形矫正程度差异无统计学意义(P>0.05)。后路组术后引流时间短于前路组,术后疼痛改善程度大于前路组,差异有统计学意义(P <0.05)。结论单纯前路或后路手术均可以有效治疗合并神经损伤的胸椎结核,但后路手术更为安全、微创,改善背部疼痛的效果也更为显著。
Objective To compare the clinical effects of anterior and posterior debridement in combination with bone graft and internal fixation for thoracic spinal tuberculosis(TB) with neurological deficits. Methods Retrospective analysis of 28 cases of thoracic spinal TB with neurological deficits from October 2009 to November 2015 was conducted, 13 cases received anterior debridement in combination with bone graft and internal fixation(anterior approach group), while 15 cases received posterior debridement in combination with bone graft and internal fixation(posterior approach group). The operation time,intraoperative blood loss, decannulation time, bone graft fusion time, the Frankel grading at the last follow-up, the visual analogue score(VAS) and the degree of correction of kyphosis were compared. Results All 28 cases were followed up. The average follow-up time was 62.4 months(26 to 86) in the anterior approach group and 37.3 months(13 to 63) in the posterior approach group. The VAS and Cobb angle of kyphosis were significantly improved one year after surgery between the anterior approach group and the posterior approach group(P <0.05). No significant difference in operation time, intraoperative blood loss, bone graft fusion time, the Frankel grading, and the degree of and the degree of correction of kyphosis were observed between the two groups(P >0.05). The average decannulation time of posterior approach group was significantly less than that of anterior approach group and significantly better back pain relief occurred in posterior approach group compared with anterior approach group(P <0.05). Conclusion One-stage anterior and posterior approach debridement in combination with bone graft and internal fixation for thoracic spinal TB with neurological deficits both can achieve good clinical results.However, the posterior approach is safer, less invasive, significantly better in back pain relief.
作者
章宏杰
陈宣维
吴文策
李哲辰
沈荣凯
林仁钦
王生淋
林建华
ZHANG Hong-jie;CHEN Xuan-wei;WU Wen-ce;LI Zhe-chen;SHEN Rong-kai;LIN Ren-qin;WANG Sheng-lin;LIN Jian-hua(Department of Spine Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,China)
出处
《中国骨与关节损伤杂志》
2019年第7期686-689,共4页
Chinese Journal of Bone and Joint Injury
关键词
胸椎结核
神经功能损伤
前路手术
后路手术
病灶清除
植骨融合
内固定
Thoracic spinal tuberculosis
Neurological deficits
Anterior approach operation
Posterior approach operation
Debridement
Bone graft
Internal fixation
