不同手术入路治疗腰椎结核的疗效比较

摘要

O bjective To explore the curative effect of different surgical methods for the treatment of lumbar tubercu -losis.Methods We analyzed retrospectively 92 cases of patients in our hospital underwent lumbar spinal tuberculosis surgery from February, 2009 to July 2015.There were 22 cases in Group A, which underwent anterior focus debridement with graft bone fusion and internal fixation;and 32 cases in group B underwent the one -stage anterior radical debride-ment , autologous iliac bone graft fusion and posterior internal fixation;38 cases in group C underwent one stage posterior focus debridement with graft bone fusion and internal fixation .We followed up all the patients for 6~24 months after op-eration and recorded their Cobb's angles , the ESR value changes before and after the surgery for two weeks , 3 months , preoperative and postoperative Frankel grading , patients in operative time ,blood loss, hospitalization days and compared them with each other .Results The patient was relieved after operation .Three groups of patients ’ Cobb 's angle and ESR value was not statistically significant (P>0.05).The hospitalization days, operation time, intraoperative blood loss in Group C were lower than Group A and B . Conclusions One stage posterior debridement with bone graft and internal fixation, anterior and posterior combined with bone graft and internal fixation and posterior approach in the treatment of lumbar tuberculosis all can achieve the goal of therapeutic effect .However , the one stage posterior debridement with bone graft and internal fixation has advantages of the shorter of hospital stay , the shorter of operation time , less blood loss, which make it a better surgical method for the treatment of lumbar tuberculosis .%目的：探究不同手术入路治疗腰椎结核疗效的差异。方法分析2009年2月～2015年7月行腰椎结核手术治疗的患者92例，A组（前路手术组）22例，行一期前路病灶清除植骨融合内固定术；B组（前后路联合手术组）32例，行一期前路病灶清除、植骨融合后路内固定术；C组（后路手术组）38例，行一期后路病灶清除植骨融合内固定术。术后跟踪随访6～24个月。记录患者术前、术后两周、3个月Cobb’ s角、ESR值变化情况，术前、术后Frankel分级的改善情况，以及患者的手术时间、术中出血量、住院天数，并进行相互比较。结果所有患者术后病情得到缓解。三组患者术前后的Cobb ’ s角、ESR值差异经比较无统计学意义（ P＞0．05）， C组患者的住院天数、手术时间、术中出血量均比A、B组低（ P＜0．05）。结论一期后路病灶清除植骨融合内固定术与前路术式、前后路联合术式在治疗腰椎结核上均能取得目标疗效。但后路术式患者的住院天数少、手术时间短、术中出血量少，是更优的手术方式。