病椎固定治疗胸、腰椎结核的疗效分析

摘要

Objective To discuss the clinical efficacy of surgical treatment of pathologic vertebral surgery for thoracic and lumbar tuberculosis. Methods All of 322 cases of thoracic and lumbar spinal tuberculosis patients from December 2003 to June 2014 were retrospectively analyzed in our department. All patients were underwent debridement, fusion and nerve decompres⁃sion surgery. According to different fixed methods, patients were divided into pathologic vertebral surgery group (fixation complet⁃ed within lesions invaded motion unit) including 91 males and 100 females, with an average age of 41.53 years, and non⁃pathologic vertebral surgery group (long segments or short segment fixation) including 61 males and 70 females, with an average age of 42.72 years. We observed the tuberculosis cure rate, degrees of deformity, pain and neurological recovery, operative time, blood loss and complications by follow⁃up. Results The average follow⁃up time was 75.52 months in pathologic vertebral surgery group and 76.21 months in non⁃pathologic vertebral surgery group. The total number of pathologic vertebras in pathologic vertebral surgery group and non⁃pathologic vertebral surgery group were 277 and 218 respectively, and the average was 1.45 and 1.66. The total number of fixed segments was 277 in pathologic vertebral surgery group and 485 in non⁃pathologic vertebral surgery group, and the average fixed segments was 1.45 and 3.70. The cure rate was 85.86%in pathologic vertebral surgery group and 85.49%in non⁃pathologic vertebral surgery group at 6 months postoperatively, and 98.95%and 98.47%at the last follow⁃up time, with no signifi⁃cant difference between groups. Graft fusion rate was 89.00%in pathologic vertebral surgery group and 89.31%in non⁃pathologic vertebral surgery group 6 months postoperatively, 98.38%and 98.47%at the last follow⁃up time, without significant difference. In lumbar spine, the average correction of Cobb's angle was 12.4° in pathologic vertebral surgery group and 13.1° in non⁃pathologic vertebral surgery group, and the average angle loss was 1.3 and 1.4°, with no significant difference. In thoracolumbar, the average correction of Cobb’s angle was 10.9°in pathologic vertebral surgery group and 11.1°in non⁃pathologic vertebral surgery group, and the average angle loss was 1.7°and 1.5° respectively, without significant difference. However, in thoracic, the average correction of Cobb's angle was 10.2° in pathologic vertebral surgery group and 12.7° in non⁃pathologic vertebral surgery group, and the average angle loss was 3.6° and 2.5°respectively, with significant difference. The mean operation time was 210.45 min in pathologic verte⁃bral surgery group and 210.45 min in non⁃pathologic vertebral surgery group, with significant difference. The average blood loss was 726.12 ml in pathologic vertebral surgery group and 726.12 ml in non⁃pathologic vertebral surgery group, with significant dif⁃ference. The complication rate was 11.51%in pathologic vertebral surgery group and 11.45%in non⁃pathologic vertebral surgery group, with no significant difference. Conclusion Pathologic vertebral surgery surgery is a safe, effective and feasible method of operation for treatment of thoracic and lumbar tuberculosis, which can effectively preserve adjacent normal vertebral motion unit features. The thoracic surgery was less satisfactory than the lumbar and thoracolumbar surgery.%目的探讨病椎间手术治疗胸、腰椎结核的疗效。方法2003年12月至2014年6月手术治疗胸、腰椎结核患者322例，根据固定方式不同分为病椎间手术组（内固定在病变侵及的运动单元中完成，共191例），男91例、女100例，平均年龄41.53岁；非病椎间手术组（采用长节段、短节段内固定，共131例），男61例、女70例，平均年龄42.72岁。两组患者术中彻底病灶清除、植骨融合、矫形、减压均在病变运动节段内完成。随访观察两组患者结核病灶治愈率、畸形矫正程度、神经功能及疼痛的恢复情况、手术时间、术中出血量及并发症的情况。结果病椎间手术组与非病椎间组平均随访时间分别为75.52个月、76.21个月。病椎间手术组与非病椎间手术组总病变节段数分别为277个、218个，平均病变节段数分别为每例1.45个、1.66个，总固定节段数分别为277个、485个，平均固定节段数分别为每例1.45个、3.70个。病椎间手术组与非病椎间手术组结核病灶治愈率术后6个月分别为85.86%、85.49%，末次随访时分别为98.95%、98.47%，差异无统计学意义；植骨融合率术后6个月分别为89.00%、89.31%，末次随访时分别为98.38%、98.47%，差异无统计学意义。病椎间手术组与非病椎间手术组腰椎Cobb角平均矫正度分别为12.4°、13.1°，平均丢失角度分别为1.3°、1.4°，差异无统计学意义；胸腰段Cobb角平均矫正度分别为10.9°、11.1°，平均丢失角度分别为1.7°、1.5°，差异无统计学意义；胸椎Cobb角平均矫正度分别为10.2°、12.7°，平均丢失角度分别为3.6°、2.5°，差异有统计学意义。病椎间手术组与非病椎间手术组平均手术时间分别为210.45 min、270.31 min，术中平均出血量分别为726.12 ml、848.23 ml，差异有统计学意义；并发症发生率分别为12.04%、12.97%，差异无统计学意义。结论病椎间手术是治疗胸、腰椎结核安全、有效、可行的手术方法，可有效保留与病椎相邻正常运动单元。胸椎病椎间手术的矫形效果略差于腰椎及胸腰段。