【摘要】 [目的]探讨经多裂肌间隙后路多节段内固定、前路单节段(有限)融合治疗腰椎结核的临床价值。[方法]选取2009年9月~2014年1月青岛市胸科医院诊断为腰椎结核并行腰椎后路内固定+前路病灶清除手术患者102例,根据后侧入路方式分为两组:后正中切口组和多裂肌间隙组。对两组的手术时间、切口长度、出血量、VAS评分、病灶清除范围、脊柱矫形、植骨融合情况、内固定取出手术时间、出血量等指标进行统计学分析。[结果]后路手术时间后正中切口组为(65.2±8.5)min,多裂肌间隙组为(41.5±6.4)min,两组比较,差异有统计学意义(P<0.05);后路切口长度分别为(12.5±1.35)cm,(5.8±0.2)cm,两组比较,差异有统计学意义(P<0.01);出血量两组分别为(208.4±25.3)ml,(97.3±18.6)ml,两组比较,差异有统计学意义(P<0.01);VAS评分在术后1周、1个月,两组比较,差异有统计学意义(P<0.05)。前路病灶清除有限融合手术病灶显露充分,能够顺利完成病灶清除和植骨融合。[结论]经多裂肌间隙入路后路内固定符合微创理论,能够满足腰椎结核后路内固定手术要求;前路单节段融合减少了对正常椎间盘的破坏,保护了脊柱功能单位,提高了患者的生活质量,值得在腰椎结核手术中推广。更多还原

【Abstract】 [Objective] To investigate the clinical value of posterior multi-segment fixation through the multifidus muscle and single-segment(limited) anterior fusion in the treatment of lumbar spinal tuberculosis.[Methods] This study included102 patients who were diagnosed with lumbar spinal tuberculosis and underwent posterior internal fixation and anterior debridement in Qingdao Chest Hospital from September 2009 to January 2014.These patients were divided into posterior midline approach group and multifidus muscle gap group according to the posterior approach.A statistical analysis was performed on operation time,incision length,blood loss,Visual Analogue Scale(VAS) score,extent of debridement,spinal orthosis,bone graft fusion,time to removal of internal fixation,and blood loss for the two groups.[Results] Compared with the multifidus muscle gap group,the posterior midline approach group had a significantly longer duration of posterior internal fixation(41.5 ±6.4 min vs 65.2 ± 8.5 min,P < 0.05),a significantly larger posterior incision length(5.8 ± 0.2 cm vs 12.5 ± 1.35 cm,P< 0.01),and significantly more blood loss(97.3 ± 18.6 ml vs 208.4 ± 25.3 ml,P < 0.01).The VAS scores at 1 week and1 month after surgery also showed significant differences between the two groups(P < 0.05).Anterior debridement and limited fusion fully exposed lesions and were successfully completed.[Conclusion] Posterior internal fixation through the multifidus muscle is minimally invasive and meets the surgical requirement of lumbar spinal tuberculosis.Single-segment anterior fusionreduces the damage to healthy intervertebral discs to protect the functional units of the patient ’s spine,improve the quality of life,and holds promise for clinical application in surgery for lumbar spinal tuberculosis.更多还原