五种不同的手术方式治疗胸腰椎结核的比较研究

目的 探讨颈椎布鲁杆菌病的早期诊断与鉴别诊断及手术治疗的疗效。 方法 回顾性分析2000年1月～2012年6月本院收治的15例颈椎布鲁杆菌病性脊椎炎患者，男11例，女4例；年龄48～78岁，平均54岁。病程6～21个月，平均10个月。其中3例合并腰椎病变；6例合并不同程度神经功能损伤，采用一期颈前路病灶清除及植骨融合内固定术。行手术治疗的患者比较手术前后日本骨科学会（Japanese Orthopaedic Association, JOA） 评分，评价预后及植骨融合情况。 结果 所有患者均获得随访，患者术后JOA评分较术前提高，差异有统计学意义（P＜0.05） 。无复发及严重并发症发生，内固定可靠，植骨融合良好。 结论 颈椎布鲁杆菌病需早期发现早期治疗，如有骨质破坏、神经功能损害应手术治疗。

Comparison among five different ways in treatment of thoracic or lumbar tuberculosis

Objective To compare clinical outcomes of 5 different ways in treatment of thoracic or lumbar tuberculosis. Methods A total of 156 patients with thoracic or lumbar tuberculosis were retrospectively analyzed. According the surgical procedures, they were divided in 5 groups： percutaneous minimally invasive focal debridement with local chemotherapy in Group A; anterior debridement, interbody autografting and anterior internal fixation in Group B ; anterior debridement and posterior bone grafting and fusion in Group C ; posterior debridement, bone grafting and posterior internal fixation in Group D ; anterior debridement, interbody autografting and posterior internal fixation in Group E. Operation time, blood loss and other indicators were analyzed. Therapeutic effect was assessed by Oswestry disability index （ODI） and kyphotic angle. Results The mean operation time, intraoperative blood loss, and the medical cost had significant differences between Group A and the other 4 groups （P 〈 O. 01 ） ; but no significant differences existed among the other 4 groups （P 〉 O. 05 ）. The average follow- up periods of 5 groups were over 15 months. No patient relapsed. The differences of ODI and kyphotic angle of 5 groups before and after treatment were statistical （P 〈 0.01 ）. Conclusion The procedures of percutaneous minimally invasive intubation irrigation under CT guidance has the similar therapeutic effect with other 4 methods, but has advantages of shorter operative time, less blood loss and lower medical cost. Therapeutic effect is similar among the others 4 traditional methods, the suitable clinical protocols should be based on individual cases.