【摘要】 目的比较不同手术入路治疗腰椎结核手术效果。方法手术治疗158例腰椎结核患者,分别采用侧前路入路手术病灶清除植骨钢板内固定59例(A组)、后路病灶清除减压内固定49例(B组)、前路减压病灶清除后路内固定50例(C组)。观察手术时间、出血量、截瘫缓解情况、植骨融合情况、后凸畸形矫正情况。结果平均手术时间:A组(170.5±18.3)min,B组(130.3±26.8)min,C组(208.5±18.3)min;平均出血量:A组(520.4±53)ml,B组(535.8±62)ml,C组(750.6±91)ml。组间比较差异有统计学意义(P<0.05)。随访9~24个月。3组均无严重并发症发生,A组1例出现结核脓肿复发,窦道形成,经前路脓肿清除后治愈,1例术中损伤髂总静脉,行修补术。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。3组的ASIA分级、Cobb角变化程度比较差异无统计学意义(P>0.05)。结论一期侧前路病灶清除植骨融合内固定术治疗胸腰椎结核,后路病灶清除植骨融合内固定术以及前后路联合术式均可获得较好的治疗效果,但手术入路的选择应根据病灶侵蚀的范围、节段、患者的耐受能力以及手术者的习惯来决定。更多还原

【Abstract】 Objective To compare the effect of different surgical approaches for lumbar tuberculosis.Methods Retrospective analysis was performed for surgical treatment of 158 cases with spinal tuberculosis,including anterior approach for surgical debridement and internal fixation of 59 cases(A group),posterior decompression and internal fixation of 49 cases(B group),and anterior decompression and posterior fixation of 50 cases(C group).Operation time,blood loss,paraplegia alleviation,interbody fusion,deformity correction were recorded.Results In A group,the average operation time was(170.5±18.3) min,blood loss(520.4±53) ml;In B group,the average operation time was(130.3±26.8) min,blood loss(535.8±62) ml;In C group,the average operation time was(208.5±18.3) min,blood loss(750.6±91) ml.Differences between the three groups was significant(P<0.05).All cases were followed up for 9~24 months.No serious complications occurred in 3 groups.In A group,1 patient had recurrence of tuberculosis abscess,sinus formation,and cured after removal of anterior abscess;1 case of iliac vein injury was repaired.Last follow-up showed all bone graft got fusion with no loosening or breakage of instruments.ASIA grade A group of nerve function in the preoperative impairment in 35 cases,33 patients improved significantly after surgery;B group,preoperative impaired in 28 cases,27 cases improved significantly after surgery,C group,23 of impaired preoperative cases,19 cases improved significantly after surgery,Cobb angle A group from the preoperative 33.6°±8.8° after operation reduced to 14.3°±5.9°;B group from preoperative to 36.4°±9.6° decreased to a postoperative of 12.4°±8.3°,C group from preoperative 35.1°±7.5° after operation reduced to 13.8°±7.8°.3 group ASIA and Cobb angle was no significant different(P>0.05).Conclusions Anterior debridement and fusion with internal fixation for thoracolumbar tuberculosis,debridement and fusion with posterior fixation and anterior-surgical treatment may be better.The choice of surgical approach is according to the scope of erosion lesions,segment,tolerance and surgical patients who used to decide.更多还原