脊柱感染性疾病前路与后路病灶清除融合固定术的安全性及疗效分析

Safety and Efficacy Analysis of Anterior and Posterior Lesion Removal and Fusion Fixation in Spinal Infectious Disease

摘要: 目的：比较前路与后路手术治疗胸腰椎结核的临床效果。方法：收集2021年1月至2023年6月在我院收住接受前路和后路治疗的40例胸腰椎感染性疾病患者的临床资料进行回顾性研究。根据两种术式不同，将患者分为两组。两组分别为前路组(n = 20)和后路组(n = 20)。前路组和后路组疗效的影响进行统计分析，两组一般资料包括：患者性别、年龄、身体质量指数、受累节段、吸烟史及既往史等。结果：术前资料：两组患者年龄，性别，身体质量指数，受累节段，既往史(心脑血管疾病、呼吸系统疾病、内分泌系统疾病、代谢性疾病及结核病史)，吸烟史，饮酒史，腰部VAS评分，腰部ODI评分及JOA评分等指标均无统计学差异(P > 0.05)。两组患者术后1月和末次随访腰部VAS评分相比差异均无显著性意义(P > 0.05)；两组患者术后3月腰部VAS评分相比差异有显著性意义(P < 0.05)。两组患者术后1月、3月和末次随访时腰部ODI评分和JOA评分相比差异均无显著性意义(P > 0.05)。两组患者术后发生硬脊膜撕裂、下肢肌间静脉血栓、下肢深静脉血栓、切口感染、窦道形成及术后复发率相比差异均无显著性意义(P > 0.05)，上述数据结果提示两种手术安全性方面无差异。前路组手术时间为121.50 ± 54.63，后路组为111.75 ± 49.84，后路组手术时间明显少于前路组组，两组间差异有统计学意义(t = 0.590, P > 0.05)；后路组术中出血量为197.50 ± 92.95，前路组为314.00 ± 131.76，后路组术中出血量明显少于前路组，两组间差异有统计学意义(t = 3.231, P < 0.05)；两组患者术后引流量相比差异均无显著性意义(P > 0.05)。结论：前路手术和后路手术在治疗脊柱感染性疾病时，均被视为有效的治疗方式选择。这两种手术方法各有其特点，但它们在安全性和疗效性上并无显著的差异。

Abstract: Objective: To compare the clinical effects of anterior and posterior surgery in the treatment of thoracolumbar tuberculosis. Methods: The clinical data of 40 patients receiving anterior and posterior treatment for thoracolumbar infectious disease from January 2021 to June 2023 were collected for retrospective study. Patients were divided into two groups according on the two different procedures. The two groups were anterior group (n = 20) and posterior group (n = 20). The effect of efficacy in the anterior and posterior groups was analyzed statistically. General data in the two groups included patient gender, age, body mass index, affected segments, smoking history and past history. Results: preoperative data: two groups of patient’s age, gender, body mass index, affected segments, past history (cardiovascular and cerebrovascular disease, respiratory diseases, endocrine system disease, metabolic disease and tuberculosis history), smoking history, drinking history, waist VAS score, waist ODI score and JOA score are no statistical difference (P > 0.05). No difference in lumbar VAS scores between 1 month and last follow-up (P > 0.05); the difference between lumbar VAS scores was significant (P < 0.05). There was no significant difference between the lumbar ODI score and JOA score at the last visit (P > 0.05). There were no significant differences in dural tear, intermuscular venous thrombosis, deep vein thrombosis, incision infection, sinus formation and postoperative recurrence rate (P > 0.05). The above data suggest no difference in the safety of the two procedures. The operation time was 121.50 ± 54.63, 111.75 ± 49.84, posterior and less (t = 0.590, P > 0.05); 197.50 ± 92.95, and 314.00 ± 131.76 in the anterior group (t = 3.231, P < 0.05); (P > 0.05). Conclusion: Both anterior surgery and posterior surgery are considered as effective treatment options in the treatment of spinal infections. These two surgical methods each have their own characteristics, but there is no significant difference in their safety and efficacy.