单纯一期后路结核病灶清除术结合椎体间植骨融合固定术治疗胸腰椎结核的疗效

摘要

目的 研究使用单纯一期后路病灶清除、椎体间植骨融合固定术治疗胸腰椎结核患者的疗效.方法 选取2009年5月至2014年1月收治的60例胸腰椎结核患者作为研究对象,按随机数字表法分为观察组和对照组,每组30例.观察组采用单纯一期后路病灶清除、椎体间植骨融合固定术;对照组采用后路固定,前路病灶清除、椎间植骨融合.术后给予9个月以上的抗结核化疗,比较2组手术时间、术中出血量、卧床时间及手术切口长度;比较2组并发症、术前和随访后后凸畸形Cobb's平均值.结果 观察组手术时间、术中出血量、切口长度及卧床时间均短于对照组,差异有统计学意义(P<0.05);术后并发症比较差异无统计学意义(P>0.05),但观察组术后感染率低于对照组;2组术后1个月、术后3个月、术后6个月Cobb's平均值比较差异有统计学意义(P<0.05).2组术后植骨融合率差异无统计学意义(P>0.05).结论 采用单纯一期后路结核病灶清除植骨术对治疗胸腰椎结核患者具有良好的效果,可达到与前后路联合术式相近的术后植骨融合率,且患者手术创伤更轻、后凸畸形纠正效果更可靠.%Objective To investigate the therapeutic effects of simple one stage posterior tuberculose focus resection combined with interbody fusion and fixation on thoracic-lumbar spinal tuberculosis .Methods Sixty patients with thoracic-lumbar spinal tuberculosis who were admitted and treated in our hospital from May 2009 to January 2014 were enrolled in the study.These patients were divided into observation group (n=30) and control group (n=30) by means of random number table method .The patients in observation group were treated by simple one stage posterior tuberculose focus resection combined with interbody fusion and fixation ,however ,the patients in control group were treated by posterior fixation +anterior debridement+interbody fusion ,after operation the patients in both groups were treated by anti tuberculosis chemotherapy for more than 9 months.Then the operation time, intraoperative bleeding volume,the time of lying in bed,operative incision length,the incidence rteas of complications , mean values of Cobb ' s before operation and after follow up were observed and compared between the two groups .Results The operation time, intraoperative bleeding volume ,the time of lying in bed and operative incision length in observation group were significantly shorter than those in control group (P<0.05).However there were no significant differences in postoperative complications betweeen two groups (P>0.05),but postoperative infection rates in observation group were lower than those in control group .Moreover there were significant differences in Cobb' s average values on 1m,3m,6m after surgery between two groups (P<0.05).However there was no significant difference in bone graft fusion rate between two groups (P>0.05).Conclusion The simple one stage posterior tuberculose focus resection combined with interbody fusion and fixation can obtain satisfactory therapeutic effects on thoracic -lumbar spinal tuberculosis ,which can get similar postoperative bone graft fusion rate as anterior -posterior combination operation method does , moreover , the kyphosis correction effects are more reliable ,with less surgical trauma .