目的分析单纯后路、单纯前路与前后联合入路治疗胸椎结核患者5年以上的随访资料，评价三种术式的中期疗效。方法回顾性分析2003年1月至2010年11月手术治疗184例胸椎结核（病变仅累及单个运动单元）患者的病历资料，男101例，女83例；年龄21~62岁，平均（39.3±14.3）岁；病程4~18个月，平均（9.6±5.0）个月。按手术方式分为三组：单纯后路组（行单纯后路病灶清除、椎体间植骨融合、钉棒内固定术，共62例）、前后联合入路组（行一期或分期后路内固定，前路病灶清除、椎体间植骨融合术，共65例）及单纯前路组（行单纯前路病灶清除、椎间植骨融合钉-棒或钉-板内固定术，共57例）。对比分析三组的手术时间、术中出血量、卧床时间、疼痛视觉模拟评分（visual analogue scale，VAS）、神经功能恢复、节段后凸Cobb角、后凸矫正率、丢失角度及并发症发生情况等，并进行统计学分析。结果术后即刻疗效比较结果显示：单纯后路组的手术时间（260.05±30.75）min、出血量（735.95±161.43）ml]优于前后联合入路组[（411.65±55.61） min、（1178.65±184.50）ml和单纯前路组[（343.65±24.74）min、（965.35±122.59）ml]；单纯后路组矫正后节段后凸Cobb角（6.78°±1.13°）及矫正率（72.48%±12.97%）、前后联合入路组（6.97°±1.05°、73.10%±11.42%）优于单纯前路组（13.98°±1.73°、44.95%±16.84%）；单纯后路组和单纯前路组卧床时间较前后联合入路组短。中期随访结果显示：末次随访单纯后路组的节段后凸Cobb角（8.56°±1.09°）及丢失角度（1.89°±1.41°）、前后联合入路组（8.55°±1.65°、1.63°±1.11°）优于单纯前路组（16.39°±1.59°、2.80°±1.29°）；三组骨性融合时间、末次VAS评分、神经功能恢复的差异无统计学意义。结论对于累及单个运动单元的胸椎结核患者行单纯后路病灶清除、椎体间植骨融合、椎弓根钉-棒系统内固定术，术后其中期随访结果显示良好，是一种安全、高效、符合“微创”理念的手术方式。%Objective To compare the minimum 5⁃year follow⁃up outcomes of surgical management by posterior only ap⁃proaches, anterior only approaches and combined posterior and anterior approaches for thoracic tuberculosis in adults, and evalu⁃ate the mid term follow⁃up results of posterior only approaches. Methods All of 184 patients with monosegment thoracic tubercu⁃losis between January 2003 and November 2010 were studied retrospectively. Among these patients, 62 cases were treated with posterior debridement combine with interbody fusion (PO group), 65 cases were treated by posterior instrumentation, anterior de⁃bridement and bone graft in one or two⁃stage procedures (AP Group ), and 57 cases were treated by anterior only approach (AO Group). The operation time, blood loss, Visual Analogue Scale, complications, recovery of neurological function, kyphosis angle, correction rate and loss angle were respectively compared between each group. Results Comparison of postoperative curative ef⁃fects showed:mean operation time and blood loss:PO group (260.05±30.75 min,735.95±161.43 ml) was better than AP group (411.65 ± 55.61 min, 1178.65 ± 184.50 ml)and AO group (343.65 ± 24.74 min, 965.35 ± 122.59 ml);corrective angle and correction rate:PO group (6.78°±1.13°, 72.48%±12.97%) and AP group (6.97°±1.05°, 73.10%±11.42%) were better than AO group (13.98°± 1.73°, 44.95%±16.84%);bed time:PO group and AO group were shorter than AP group. Mid term follow⁃up outcomes showed:ky⁃phosis angle and loss angle:PO group (8.56°±1.09°, 1.89°±1.41°) and AP group (8.55°±1.65°, 1.63°±1.11°) were better than AO group (16.39°±1.59°, 2.80°±1.29°);bone fusion time, VAS and recovery of neurological function:there were no statistically differ⁃ence in all groups. Conclusion The mid term follow⁃up outcomes of posterior debridement combined with interbody fusion is sat⁃isfied in the management of monosegment thoracic tuberculosis. It is a safe and effective method.
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