摘要
目的探讨小切口技术在胸腰椎结核前路手术中的应用价值。方法回顾分析2015年1月-2018年1月收治的65例采用后前路联合手术治疗的胸腰椎结核患者临床资料,根据前路手术切口长度分为小切口手术组(A组29例)和传统切口手术组(B组36例)。两组患者性别、年龄、病程、病变节段、美国脊髓损伤协会(ASIA)分级及术前疼痛视觉模拟评分(VAS)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、脊柱后凸Cobb角等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组前路手术切口长度、手术时间、术中出血量、术后并发症、住院时间及ESR、CRP;术后采用VAS评分评价疼痛恢复情况;测量脊柱后凸患者病变椎体Cobb角,并计算Cobb角角度丢失及矫正率;根据Bridwell植骨融合标准评定植骨融合情况。结果 A组患者前路手术切口长度、手术时间、术中出血量及住院时间均显著小于B组(P<0.05)。两组患者均获随访,随访时间12~29个月,平均20个月。A、B组分别有4例(13.8%)和14例(38.9%)出现术后并发症,发生率差异有统计学意义(χ~2=5.050,P=0.025)。两组术后6个月ESR和CRP均降至正常范围,术后3、6个月及末次随访时两组ESR和CRP差异均无统计学意义(P>0.05)。两组患者末次随访时神经功能均较术前明显恢复,两组间比较差异无统计学意义(Z=0.167,P=0.868)。两组术后各时间点VAS评分均较术前显著下降(P<0.05);A组术后1 d VAS评分显著低于B组(t=-2.317,P=0.024),但末次随访时两组比较差异无统计学意义(t=-0.862,P=0.392)。两组脊柱后凸畸形患者术后1 d及末次随访时Cobb角均较术前显著减小(P<0.05),术后1 d与末次随访时比较差异无统计学意义(P>0.05);两组术后Cobb角以及角度丢失和矫正率比较差异均无统计学意义(P>0.05)。两组患者末次随访时植骨全部达骨性融合,术后6个月、1年及末次随访时两组植骨融合率差异均无统计学意义(P>0.05)。末次随访时两组患者结核病灶均治愈,无结核复发。结论胸腰椎结核前路手术中采用小切口技术可以达到和传统切口手术相似的治疗效果,并且具有创伤小、术后并发症少、患者术后恢复快等优点。
Objective To investigate the value of small incision approach in the anterior surgery of thoracic and lumbar spinal tuberculosis. Methods A clinical data of 65 patients with thoracic or lumbar spinal tuberculosis treated with posterior-anterior surgery between January 2015 and January 2018 was retrospectively analyzed. The patients were divided into small incision group(group A, 29 patients) and traditional incision group(group B, 36 patients) according to the length of anterior incision. There was no significant difference in general data such as gender, age, disease duration,segment of lesion, American Spinal Cord Injury Association(ASIA) grading, preoperative pain visual analogue scale(VAS) score, erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), and Cobb angle of spinal kyphosis between2 groups(P>0.05). The length of anterior incision, operation time, intraoperative blood loss, postoperative complications,postoperative hospitalization time, ESR, and CRP were recorded and compared. The VAS score was used to evaluate the pain after operation. The Cobb angles in patients with spinal kyphosis were measured and the loss of angle and correction rate of angle were calculated. The result of bone graft fusion was assessed according to the Bridwell standard. Results The length of anterior incision, operation time, intraoperative blood loss, and hospitalization time of group A were all significantly less than those of group B(P<0.05). All patients in both groups were followed up 12-29 months(mean, 20 months). There were 4 cases(13.8%) and 14 cases(38.9%) of postoperative complications in groups A and B respectively,showing significant difference(χ~2=5.050, P=0.025). The ESR and CRP in 2 groups all returned to normal at 6 months after operation, and there was no significant difference in ESR and CRP between 2 groups at 3 months, 6 months, and last follow-up(P>0.05). At last follow-up, the neurological function of patient with neurological symptoms was significantly better than that before operation, and there was no significant difference between 2 groups(Z=0.167, P=0.868). The VAS scores of 2 groups at each time point after operation were significantly lower than those before operation(P<0.05);the VAS score in group A was significantly lower than that in group B(t=-2.317, P=0.024) at 1 day after operation, but there was no significant difference between 2 groups(t=-0.862, P=0.392) at last follow-up. Among the patients with kyphosis,the Cobb angle was significantly decreased at 1 day after operation and last follow-up when compared with preoperative angle(P<0.05);but there was no significant difference between 1 day after operation and last follow-up(P>0.05). There was no significant difference in Cobb angle, loss of angle, and correction rate between 2 groups after operation(P>0.05).The bone graft healed well at last follow-up in 2 groups. There was no significant difference in bone graft fusion rate between 2 groups at 6 months after operation, 1 year after operation, and last follow-up(P>0.05). At last follow-up, all patients cured, and no recurrence occurred. Conclusion In the anterior surgery of thoracic and lumbar tuberculosis, the application of small incision approach can achieve the similar effectiveness as traditional incision surgery with the advantages of minimally invasive, less complications, and quick recovery.
作者
施建党
何进文
牛宁奎
杨宗强
袁海峰
丁惠强
SHI Jiandang;He Jinwen;NIU Ningkui;YANG Zongqiang;YUAN Haifeng;DING Huiqiang(Department of Spinal Orthopedics,General Hospital of Ningxia Medical University,Yinchuan Ningxia,750004,P.R.China;School of Clinical Medicine,Ningxia Medical University,Yinchuan Ningxia,750004,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2019年第6期698-706,共9页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81760399)~~
关键词
胸腰椎结核
前路手术
小切口
病灶清除
微创
Thoracic and lumbar tuberculosis
anterior surgery
small incision
debridement
minimally invasive
