摘要
目的比较前路和后路内固定方法治疗胸腰椎结核的疗效。方法2004年1月至2009年12月解放军第三。九医院骨科采用病灶清除、植骨融合及前路或后路固定方法治疗成年胸腰椎结核患者241例，189例获得平均37个月的随访（22—72个月）。其中157例患者术前四联（HRZE）抗结核药物治疗3～6周，其余32例伴有脊髓、神经压迫症状，抗结核药物治疗6～18h后手术治疗。除8例跳跃性胸腰椎结核患者采用杂交的前路和后路内固定术外，前路固定方法治疗74例（A组），后路固定方法治疗107例（B组）。结果术后3～6周两组患者的局部症状明显减轻。A组14例术前伴有脊髓神经损伤症状，术后10例（71％）恢复良好（ODI功能障碍指数〉50％）；B组19例伴有脊髓神经损伤症状，术后14例（74％）恢复良好（P〉0．05）。两组患者术前红细胞沉降率分别为43．6mm／h和42．4mm／h，术后8～12周恢复正常。术后脊柱后凸畸形矫正角度A组为11．5。，B组为12．6。（P〈0．01）。末次随访时，A组矫正角度丢失为6．8°，B组为6．1°（P〈0．01）；A组融合率为92．5％，B组为91．8％（P〉0．05）。两组患者均没有严重的手术并发症发生。结论只要手术适应证选择正确，胸腰椎结核在不同手术方式下采用前路或后路内固定治疗，都能获得较好疗效。但后路固定在矫正后凸畸形并维持矫正角度方面要优于前路固定。
Objective To compare the outcomes of anterior verus posterior instrumentation under different surgical procedures in the surgical management of thoracolumbar spinal tuberculosis （TB）. Methods Between January 2004 and December 2009, 241 adult patients with thoracolumbar spinal TB underwent radical debridement and strut grafting plus anterior or posterior instrumentation in single-stage or two-stages. The mean age was 39 years （range：16 -67）. The mean follow-up period for 189 patients was 37 months （range：22 -72）. Among them, 157 cases underwent 〉 3 weeks of chemotherapeutic regimen of isoniazid, rifampin, pyrazinamide and ethamburoI and the remaining 32 were operated for neurological impairment after 6 - 18 h with the same chemotherapeutic regimen. Except for 8 patients with skip lesions undergoing hybrid anterioposterior instrumentation, anterior instrumentation was utilized in 74 patients （Group A） and posterior instrumentation in 107 patients （Group B ）. Results In both groups, local symptoms of all patients were relieved significantly 1 -3 weeks postoperatively. And 10/14 cases （71% ） in Group A and 14/19 cases （74%） in Group B with neurological deficits had excellent or good clinical outcomes （P 〉 0. 05）. The levels of erythrocyte sedimentation rates （ESR） returned from 43.6 mm/h and 42.4 mm/h preoperatively to normal at 8 - 12 weeks postoperatively. Kyphosis degrees were corrected by a mean of 11.5~ in Group A and 12. 6~ in Group B （P 〈0. 01 ）. The correction loss was 6. 8° in Group A and 6. 1° in Group B at the last follow-up （P 〈0.01 ）. Fusion rates of the grafting bone were 92. 5% and 91.8% respectively at the final follow-up （ P 〉 0. 05 ）. Severe complications did not occur. Conclusion Either anterior or posterior instrumentation can obtain good results in correction and maintenance of deformity, clearance of foci, decompression of spinal cord and pain relief in the treatment of thoracolumbar spinal TB as long as the surgical indications are properly selected. Posterior instrumentation may be superior to anterior instrumentation in the correction and maintenance of deformity.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第19期1325-1329,共5页
National Medical Journal of China
关键词
结核
脊柱
内固定器
治疗结果
Tuberculosis, spinal
Internal fixators
Treatment outcome
