单纯后路病灶清除固定与单纯前路手术治疗腰椎结核的临床病例分析

Analysis of Clinical Cases for Treating Lumbar Tuberculosis with Lesion Clearing through Only Posterior and Anterior Approach

摘要: 目的：探讨一期单纯后路病灶清除植骨椎弓根螺钉内固定与一期单纯前路病灶清除椎体内固定手术治疗腰椎结核的临床疗效比较。方法：回顾性分析自2011年10月至2016年8月曲靖市第一人民医院骨一科手术治疗脊柱结核患者16例，平均分两组，治疗组：一期单纯后路病灶清除椎弓根螺钉内固定；对照组：一期单纯前路病灶清除椎体内固定。两组患者脊柱稳定性均明显破坏，两组患者性别、年龄、病程、病变节段以及并发症等一般资料比较，差异均无统计学意义(P > 0.05)，具有可比性。比较两组患者后凸畸形矫正率、手术时间、术中出血量、术后植骨融合时间；结果：治疗组矢状面平衡Cobbs角平均矫正35.6˚，矫正率76.8%；对照组矢状面平衡Cobbs角平均矫正20.8˚，矫正率52.6%，矫正率治疗组和对照组对比有明显改善(P < 0.05)。治疗组手术平均时间和手术平均出血量均较对照组明显缩短和减少(P < 0.05)；椎体间植骨界面骨性融合时间单纯后路组14.5 ± 1.5 W，单纯前路组13.5 ± 1.0 W，两组患者骨性融合时间比较，差异均无统计学意义(P > 0.05)。结论：一期单纯后路病灶清除椎弓根螺钉内固定与一期单纯前路病灶清除椎体内固定手术治疗腰椎结核的临床疗效比较有明显优势，治疗组和对照组对比矫正率有明显改善(P < 0.05)，治疗组手术平均时间和手术平均出血量均较对照组明显缩短和减少(P < 0.05)；两组患者骨性融合时间比较，差异均无统计学意义(P > 0.05)，可获得满意临床疗效。

Abstract: Objective: Analysis of clinical cases for treating lumbar tuberculosis with lesion clearing through only posterior and anterior approach. Methods: To analyze 16 patients suffered from spinal tuberculosis retrospectively, patients being treated with surgery in The First People’s Hospital of Qujing city Yunnan province from October 2011 to February 2016 were divided into two goups on average. Treatment group were treated with lesion clearing through only posterior while control group with only anterior approach. Two groups of patients with spinal stability significantly damaged have no statistically significant difference about gender, age, course of the disease, pathological changes section and complications (P > 0.05). Result: The average Cobbs Angle on the sagittal plane of Treatment group is 35.6˚ and the correct rate is 76.8%; while that of Control group is 20.8˚ and the correct rate is 52.6%. The treatment group has gotten a high cor-rection rate than control group (P < 0.05). The average operation time and average blood loss of treatment group is obviously shorten than the control group (P < 0.05); osseous fusion time of treatment group is 14.5 ± 1.5 W, and that of Control group 13.5 ± 1.0 W. There was no statistically significant difference in osseous fusion time between the two groups (P > 0.05). Conclusion: The single posterior approach for treating lumbar tuberculosis with lesion clearing pedicle screw fixation has more obvious advantages than the single anterior lesion clearance. In combi-nation with vertebral body fixed, the treatment group has gotten a high correction rate than control group (P < 0.05). The average operation time and average blood loss of treatment group is obviously shorten than the control group (P < 0.05); there was no statistically significant difference in osseous fusion time between the two groups, and the clinical effect of only posterior approach for treating lumbar tuberculosis with lesion clearing in combination with pedicle screw fixed was satisfactory.