【摘要】 目的比较前后路联合术式与后路病灶清除结合钛网结构性植骨内固定术在胸腰椎结核治疗中的临床效果。方法将2012年1月至2016年12月我院收治的86例胸腰椎结核患者随机分为两组,A组45例,B组41例。A组行后路病灶清除结合钛网结构性植骨内固定术治疗,B组行前后路联合手术治疗。观察两组手术情况、术后恢复情况、ODI评分、Cobb’s角变化及术后并发症发生情况。结果 A组术中出血量少于B组,差异显著(P<0.05);A组手术时间、术后首次肛门排气时间、术后首次下床时间及术后住院时间均短于B组,差异显著(P<0.05)。术前,两组患者ODI评分及Cobb’s角比较,差异无统计学意义(P>0.05);术后1、12周,两组患者ODI评分与Cobb’s角均明显优于术前,差异显著(P<0.05),组间比较,差异无统计学意义(P>0.05)。A组术后并发症总发生率为4.44%,明显低于B组的19.51%,差异显著(P<0.05)。结论前后路联合术式与后路病灶清除结合钛网结构性植骨内固定术对胸腰椎结核均有确切治疗效果,但后者手术时间较短,术中出血较少,术后恢复快,且具有更高的安全性,更值得在临床中推广使用。更多还原

【Abstract】 Objective To compare the clinical effects of anterior and posterior combined surgery and posterior debridement combined with titanium mesh structural bone grafting internal fixation for thoracolumbar tuberculosis.Methods A total of 86 patients with thoracolumbar tuberculosis admitted in our hospital from January 2012 to December 2016 were divided into two groups. There were 45 patients in the group A and 41 patients in the group B, the group A was treated with posterior debridement combined with titanium mesh structural bone grafting internal fixation, while the group B was treated with anterior and posterior combined surgery. The surgical condition, postoperative recovery, the scores of ODI, changes of Cobb’s angle and incidences of postoperative complications were compared in the two groups.Results The intraoperative blood loss in the group A was less than that in the group B, the difference was statistically significant(P<0.05); the operation time, the postoperative first exhausting time, the postoperative first ambulation time and the postoperative hospital stay in the group A were shorter than those in the group B, the differences were statistically significant(P<0.05). Before operation, there were no significant differences in ODI scores and Cobb’s angle between the two groups(P >0.05); at 1 and 12 weeks after operation, the ODI scores and Cobb’s angles of the two groups were significantly better than those before operation, the differences were statistically significant(P <0.05), but there were no significant differences between the two groups(P>0.05). The total incidence of postoperative complications in the group A was 4.44%, which was significantly lower than 19.51% in the group B, the difference was statistically significant(P<0.05). Conclusion Both anterior and posterior combined surgery and posterior debridement combined with titanium mesh structural bone grafting internal fixation have a definite therapeutic effect on thoracolumbar tuberculosis,but the latter has a shorter operation time, less intraoperative bleeding loss and quick recovery after surgery. It is more safety, which is worthy of promotion and application in clinic.更多还原