一期前路、后路、前后路聯(lián)合病灶清除治療脊柱結(jié)核的臨床效果

秦英 梁勝根 陳忠羨

【摘要】 目的：分析一期前路、后路、前后路聯(lián)合手術(shù)治療脊柱結(jié)核的臨床效果。方法：回顧性分析2005年1月-2018年1月本科手術(shù)治療的130例脊柱結(jié)核患者的資料，按照手術(shù)入路的不同分為前路組62例，后路組48例，前后路聯(lián)合組20例，比較三組患者住院時(shí)間、手術(shù)時(shí)間、術(shù)中出血量、Cobb角矯正率、并發(fā)癥的發(fā)生率、骨融合率之間的差異。結(jié)果：前后路聯(lián)合組的住院時(shí)間、手術(shù)時(shí)間、出血量多于前路組及后路組（P<0.05）;前路組的出血量多于后路組，后路組及前后路聯(lián)合組在后凸Cobb角矯正率方面優(yōu)于前路，前路及前后路聯(lián)合組的并發(fā)癥發(fā)生率高于后路組（P<0.05）;融合率各組間比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：前路及后路手術(shù)均能有效治療脊柱結(jié)核，但后路手術(shù)相對(duì)于前路手術(shù)出血量更少，并發(fā)癥發(fā)生率更低，后凸畸形矯正率更高。

【關(guān)鍵詞】 脊柱結(jié)核; 病灶清除; 內(nèi)固定; 手術(shù)入路

【Abstract】 Objective：To compare the clinical effect of anterior alone，posterior alone and anterior combined with posterior treatment on spinal tuberculosis.Method：This study retrospectively reviewed 130 patients? treated in our department from Jan 2005 to Jan 2018.According to operation approach，they were separated into three groups.The anterior group undergoing anterior debridement with internal fixation（n=62）.The posterior group undergoing posterior debridement with internal fixation（n=48）.The anterior combined with posterior group undergoing anterior debridement combined with posterior internal fixation（n=20）.The hospitalization days，operation time，intraoperative blood loss ，Cobbs angle correction，complication rate，fusion rate were recorded and evaluated among three groups.Result：The hospitalization days，operation time and blood loss in anterior combined with posterior group were much more than those of anterior group and posterior group（P<0.05）.The operation blood loss in anterior group was higher than that of posterior group（P<0.05）.The Cobbs angle correction in posterior group and anterior combined with posterior group were more effective than that of anterior group，the difference was statistically significant（P<0.05）.The complication rate in anterior group and anterior combined with posterior group were higher than that of posterior group，the difference was statistically significant（P<0.05）.There were no significant differences in fusion rate between the groups（P>0.05）.Conclusion：Both anterior approach and posterior approach are effective on treatment of spinal tuberculosis.Posterior approach treatment is better than anterior approach for less blood loss，more effective Cobbs angle correction and less complications.

【Key words】 Spinal tuberculosis; Debridement; Internal fixation; Surgical approach

First-authors address：Sun Yat-sen University Affiliated Jiangmen Hospital，Jiangmen 529030，China

doi：10.3969/j.issn.1674-4985.2019.16.034

前路病灶清除術(shù)治療脊柱結(jié)核具有減壓直接、植骨面積大、融合率高等優(yōu)點(diǎn)[1]。近年來部分學(xué)者嘗試從后路進(jìn)行病灶清除，獲得了良好的臨床效果[2]。而對(duì)于特殊類型的脊柱結(jié)核，有學(xué)者建議采取前后路聯(lián)合的方法進(jìn)行病灶清除[3]。本文收集本科開展的130例脊柱結(jié)核病灶清除手術(shù)患者，分析各種手術(shù)方式的臨床效果。