单纯后路手术治疗胸腰段脊柱结核的疗效及安全性研究

目的:研究单纯后路手术治疗胸腰段脊柱结核的临床疗效及安全性。方法:选取84例胸腰段脊柱结核确诊患者作为本次研究对象,根据随机数表法分为对照组与研究组,每组各42例。对照组在2周抗结核治疗后给予前路脊柱手术治疗;观察组在2周抗结核治疗后采用后路脊柱手术。统计比较两组患者的平均手术时间、术中出血量、住院时间、视觉模拟评分(visual analogue scale/score,VAS)、日本骨科学会颈椎病疗效评定标准(Japanese orthopaedic association scores for assessment of cervical myelopathy,JOA)评分、Cobb’s角、临床疗效以及术后并发症的发生率。结果:观察组平均手术时间、术中出血量以及住院时间相较于对照组缩短,差异有统计学意义(P<0.05);观察组VAS及JOA评分优于对照组患者,差异有统计学意义(P<0.05);治疗前,两组后凸Cobb’s角差异无统计学意义(P>0.05);术后,后凸Cobb’s角均有改善,且观察组后凸Cobb’s角矫正效果更佳,差异有统计学意义(P<0.05);观察组的临床疗效95.24%,优于对照组76.19%,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:单纯后路手术治疗胸腰段脊柱结核可以有效改善伤椎高度丢失、矫正脊椎后凸畸形,缩短患者手术与住院时间,降低术中出血量,手术疗效更确切、安全,是治疗脊柱结核的合理选择。

Efficacy and safety of posterior spinal surgery in the treatment of thoracolumbar spine tuberculosis

Objective:To study the clinical efficacy and safety of posterior spinal surgery in the treatment of thoracolumbar spine tuberculosis.Methods:84 cases of patients with thoracolumbar spine tuberculosis were selected as the subjects.According to the random table method,84 cases were divided into two group,each group had 42 cases.Patients in control group were given anterior spinal surgery after 2 weeks of anti-tuberculosis treatment,patients in observation group were given posterior spinal surgery after 2 weeks of anti-tuberculosis treatment.The average time of operation,intraoperative blood loss,hospitalization time,VAS score,JOA score,Cobb's angle,clinical efficacy,and the occurrenceof postoperative complications were compared between two groups.Results:The average operative time,intraoperative blood toss and hospitalization time of the observation group were less than those in the control group,the differences were statistically significant (P ＜ 0.05).The VAS and JOA scores in the observation group were better than those of the control group,the difference was statistically significant (P ＜ 0.05).There was no significant difference in the preoperative Cobb's angle between the two groups (P ＞ 0.05).The posterior convex Cobb's angle was improved in postoperatively,and the effect of posterior convex Cobb's angle correction was better than that in the observation group,and the difference was statistically significant(P ＜ 0.05).The clinical efficacy of the observation group was 95.24％ (40/42),which was better than that of the control group (76.19％,32/42),the difference was statistically significant(P ＜ 0.05).The occurrence of complications in the observation group was lower than that in the control group,the difference was statistically significant (P ＜ 0.05).Conclusion:Posterior spine surgery in the treatment of thoracolumbar spine tuberculosis can effectively improve the loss of vertebral height,correction of kyphosis,shorten the patient's surgery,hospital stay,reduce intraoperative blood loss,surgical treatment more accurate and safe,is a reasonable choice for spinal tuberculosis.