鞠尚廉^1,,
杨群^2,,
1. 大连医科大学附属第二医院 骨外科, 辽宁 大连 116023
2. 大连医科大学附属第一医院 脊柱外科, 辽宁 大连 116011

详细信息 作者简介: 鞠尚廉(1993-), 男, 主治医师。E-mail: jushanglian@foxmail.com


通讯作者: 杨群, 教授。E-mail: yangqun@medmail.com.cn 中图分类号: R681.2


摘要:目的分析前路与后路的病灶清除植骨融合内固定术在治疗脊柱结核时的临床效果。方法收集2017年1月至2019年10月大连医科大学附属第一医院脊柱外科收治的41例脊柱结核患者的临床资料，所有患者术前规范的抗结核药物治疗2~3周，按术式分为前路病灶清除植骨融合内固定术23例（A组），后路病灶清除植骨融合内固定术18例（B组），A组术前ASIA分级B级2例，C级6例，D级7例，E级8例，术前Cobb角（27.4±10.5）°；B组术前ASIA分级B级1例，C级4例，D级6例，E级7例，术前Cobb角（24.7±6.6）°。比较两组手术时间、术中出血量以及住院时间的差异，通过神经系统查体评价术后神经功能改善情况，定期复查X光、CT观察植骨融合情况及Cobb角畸形的矫正与维持情况，术后随访4~18个月，综合评价两种术式的临床效果。结果A组手术时间（385±115）min，B组手术时间（374±94）min；A组术中出血量（780±508）mL，B组术中出血量（659±453）mL；A组住院时间（28.3±12.3）d，B组住院时间（26.3±7.4）d；A组术前与术后Cobb角矫正（20.5±9.8）°，B组Cobb角矫正（17.7±6.9）°；A组术后与末次复查比较矫正后角度丢失0.44（0.25，0.69）°，B组角度丢失0.56（0.12，0.71）°，A组15例及B组11例共计26例神经功能障碍患者ASIA分级均恢复1~2级。以上数据两组间差异均无统计学意义（P>0.05）。两组植骨融合率均达到100%，且两组融合时间无统计学差异。结论在良好的术前准备和术前评估的基础上，根据个体情况合理地制定手术方案，前路和后路病灶清除植骨融合内固定术均可以取得理想的临床效果。
关键词: 脊柱结核/
手术入路/
疗效


Abstract:ObjectivesTo analyze the clinical effects of anterior and posterior debridement fusion internal fixation in the treatment of spinal tuberculosis.MethodsWe collected the clinical data of 41 cases of spinal tuberculosis in the spinal surgery department of the First Affiliated Hospital of Dalian Medical University from January 2017 to October 2019. All patients were treated with standardized anti-tuberculosis drugs for 2 to 3 weeks before surgery, and were divided into two groups according to the surgery procedure, including group A with anterior approach debridement, fusion and internal fixation (n=23) and group B with posterior approach debridement, fusion and internal fixation (n=18). In group A, there were 2 cases with preoperative ASIA grade B, 6 cases with grade C, 7 cases with grade D, and 8 cases with grade E, the preoperative Cobb angle was (27.4±10.5)°. In group B, there was 1 case with preoperative ASIA grade B, 4 cases with grade C, 6 cases with grade D, and 7 cases with grade E, the preoperative Cobb angle was (24.7±6.6)°. The differences in operative time, intraoperative blood loss and hospitalization time between the two groups were compared, and the postoperative neurological function was evaluated by neurological examination, and the fusion of bone graft and the correction and maintenance of Cobb angle deformity were observed by regular follow-up X-ray and CT, and the clinical results of both procedures were comprehensively evaluated after 4-18 months follow-up.ResultsThe operation time of group A and group B was (385±115) min and (374±94) min respectively, there was no statistical difference between the two groups (P>0.05). The amount of blood loss in group A was (780±508) mL, which was similar to (659±453) mL in group B (P>0.05). The length of stay of group A was (28.3±12.3) d, and group B was (26.3±7.4) d. The Cobb angle of group A was corrected (20.5±9.8)° postoperatively; the Cobb angle of group B was corrected (17.7±6.9)°; The postoperative Cobb angle loss of group A was 0.44 (0.25, 0.69)° at the last review; the angle loss of group B was 0.56 (0.12, 0.71)°. There was no statistical difference between the two groups (P>0.05). Comparison of the correction and maintenance of Cobb angle in pre-operation and post-operation revealed no statistical difference between the two groups (P>0.05). There was a total of 26 patients with neurological dysfunction in group A and group B, and all of them were recovered from grade 1 to 2. There was no statistical difference between the two groups (P>0.05). The fusion rate of bone graft in the two groups was 100%, and there was no statistical difference between the two groups.ConclusionUnder good preoperative preparation and preoperative assessment, with the basis of reasonable operation according to individual circumstance, both anterior and posterior approach debridement, fusion and internal fixation can obtain ideal clinical effect.
Keywords:spinal tuberculosis/
surgical approaches/
effect

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