摘要
[目的]研究脊柱结核的不同术式选择,并评价其疗效和预后。[方法]选取本院收治的脊柱结核患者147例,根据患者情况选择适宜的手术方式,分为四组进行对比研究,包括:前路病灶清除、植骨融合及前路内固定术(A组),前路病灶清除、植骨融合及后路椎弓根内固定术(B组),胸腰侧前方病灶清除及后路椎弓根内固定术(C组),后路病灶清除、植骨融合及后路内固定术(D组)。从创伤指标、影像学指标、化验指标及脊髓神经功能损伤的恢复情况进行手术后疗效的评价。[结果]C、D组的手术时间及术中出血量相当,且远远小于A、B组,而B组手术时间及术中出血量明显高于其他三组;采用前路固定术式的A组患者脊柱后凸畸形的矫正率低于采用后路固定的B、C、D组患者,而矫正角度丢失率明显高于B、C、D组。A组术后并发症最多,各组植骨融合时间差异较小。各组脊髓神经功能损伤的恢复情况(Frankel分级)均较好。以上比较差异均具有统计学意义,P<0.05。[结论]根据不同患者的适应证选择合适的手术方式有明显的临床意义,有助于在清除病灶、矫正畸形的基础上维持正常脊柱功能,建议进行临床推广。
[Objective] To explore selection of different surgical treatments for spinal tuberculosis,and evaluate their efficacy and prognosis. [Methods] A total of 147 patients with spinal tuberculosis were surgically treated with different operations on a case- by- case basis. The surgical procedures were grossly divided into four groups as follows： Group A,anterior debridement,interbody fusion and anterior fixation; Group B,anterior debridement and fusion,combined with posterior pedicle screw fixation; Group C,anterolateral thoracic debridement and posterior pedicle screw fixation; and Group D,posterior debridement,bone graft fusion and posterior fixation. Trauma index,imaging parameters,laboratory tests,recovery of neurological function,and clinical outcomes were evaluated and compared among the groups. [Results] The operation time and hemorrhage in the Group C and D were similar respectively,by contrast,considerably less than those in the Group A and B. The Group B consumed the longest operation time,associated with the most intraoperative blood loss among the 4 groups. Correction of kyphosis achieved with the anterior fixation in the Group A was significantly inferior to the posterior fixation in Group B,C and D.while the most loss of correction was also observed in the Group A compared with the remaining 3 groups. However,satisfactory recovery of neurological function in Frankel grade was gained by all of the 4 surgical procedures. [Conclusion] Selection of a suitable surgical procedure on a case- by- case basis has obvious clinical significances,which is helpful to achieve a reasonable consequence of treatment for spinal tuberculosis based on appropriate debridement,correction of deformity and restabilization of the spine.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2015年第21期1943-1946,共4页
Orthopedic Journal of China
基金
2013年湖北省自然科学基金项目(编号:2013CFB269)
关键词
手术治疗
术式选择
脊柱结核
疗效评价
surgical treatment
surgical options
spinal tuberculosis
evaluation
