一期前路病灶清除椎体间植骨内固定与保守方案治疗颈胸段脊柱结核的比较

摘要

目的 探讨保守方案与一期前路病灶清除椎体间植骨内固定方案治疗颈胸段脊柱结核的治疗效果.方法 选取我院2009年3月至2014年8月收治的颈胸段脊柱结核患者130例,以随机抽签法分为两组:保守组(保守方案治疗,65例)和手术组(一期前路病灶清除椎体间植骨内固定方案治疗,65例).比较两组患者治疗前后疼痛视觉模拟评分(visual analogue scale,VAS)、Frankel脊髓功能分级、红细胞沉降率(erythrocyte sedimentation rate,ESR)正常率、C反应蛋白(C-reactive protein,CRP)正常率、椎体重建高度及椎体后凸Cobb角畸形矫正角度等.结果 手术组患者治疗后2周和1、3、6、12个月的VAS评分均显著低于保守组,差异均有统计学意义(均P<0.05).手术组患者治疗后Frankel分级显著优于治疗前、保守组,差异均有统计学意义(均P<0.05).手术组患者随访ESR和CRP正常率显著高于保守组,差异均有统计学意义(均P<0.05).手术组患者随访椎体重建高度和椎体后凸Cobb角畸形矫正角度均优于保守组,差异均有统计学意义(均P<0.05).结论 相较于保守方案,一期前路病灶清除椎体间植骨内固定方案治疗颈胸段脊柱结核可有效缓解机体疼痛,改善受损脊髓功能,加快康复进程,并有助于降低炎症反应水平.%Objective To investigate the clinical efficacy difference of conservative therapy and surgical therapy by one-stage anterior debridement, bone grafting and internal fixation for patients with cervico-thoracic spinal tuberculosis. Methods One hundred and thirty patients with cervicothoracic spinal tuber-culosis in the period from March 2009 to August 2014 in our hospital were chosen and randomly divided into two groups:conservative therapy group (65 patients) with conservative therapy, and surgical therapy group (65 patients) with surgical therapy by one-stage anterior debridement, bone grafting and internal fixation. The VAS score and the spinal cord function classification before and after treatment, the ambulation rate, erythrocyte sedi-mentation rate (ESR) normal rate, C-reactive protein (CRP) normal rate, vertebral reconstruction height and deformity correction angle were compared between two groups. Results The VAS score at 2nd week, 1st month, 3rd month, 6th month and 12th month after treatment in surgical therapy group was significantly lower than in conservative therapy group (P<0.05). The spinal cord function classification after treatment in surgical therapy group was significantly better than in conservative therapy group and before treatment (P<0.05). The ESR normal rate and CRP normal rate in surgical therapy group during the follow-up period were significantly higher than those in conservative therapy group (P<0.05). The vertebral reconstruction height and deformity correction angle in surgical therapy group were significantly higher than in conservative therapy group ( P<0.05). Conclusion As compared with conservative therapy, surgical therapy by one-stage anterior debride-ment, bone grafting and internal fixation for patients with cervicothoracic spinal tuberculosis can effectively relieve the body pain, improve the injured spinal cord function, speed up the disease recovery progressand be helpful to reduce the inflammatory response levels.