单纯后路与一期前后路手术治疗胸腰椎结核

 目的 探讨单纯后路手术与一期前后路手术治疗胸腰椎结核是否有同等疗效。方法 收集了2003年5月至2008年10月我院骨科采用椎弓根螺钉固定联合病灶清除植骨融合治疗的胸腰椎结核患者58例资料,其中单纯后路手术组30例,一期前后路手术组28例,均采用标准疗程三联或四联抗结核方案。比较两组患者围手术期指标,随访临床疗效、实验室及影像学资料,随访时间为43~108个月。结果 两组患者在住院时间、手术时间、出血量、输血量、引流天数及引流量等方面的差异有明显统计学意义。所有患者的临床症状均得到有效改善。单纯后路组1例术后3年出现肋骨结核及窦道,1例术后4年出现其他部位结核,手术部位均未见复发。后凸Cobb角矫正均较满意。结论 两种术式治疗短节段胸腰椎结核疗效相当,单纯后路手术创伤较小,疗效满意,适用于不能耐受前路手术及双侧腰大肌脓肿的患者。

Posterior surgery alone and one-stage combined anterior-posterior surgery for the treatment of thoracic and lumbar tuberculosis

Objective To investigate whether the posterior surgery and one stage combined anterior posterior surgery for the treatment of thoracic and lumbar tuberculosis had the same effect.Methods From May 2003 to October 2008,fifty eight patients of thoracic and lumbar tuberculosis were treated by posterior pedicle screw fixation combined debridement,bone graft and fusion.Thirty of them were treated with posterior surgical procedure alone (group 1).Twenty eight patients were treated with one stage combined anterior posterior surgery (group 2).All patients were managed by standard courses of chemotherapy with triple or quadruple anti TB drugs.The perioperative indicators were compared.The clinical effects,laboratory and image data were followed up for 43-108 months.Results There were statistically significant differences in length of hospital stay,operative time,bleeding,blood transfusions,drainage time and drainage amount in two groups.The clinical symptoms had obvious relief in all cases.In group 1,one patient had rib tuberculosis and a fistula formation in the 3rd year,one patient had pulmonary and knee tuberculosis in the 4th year,but spinal tuberculosis and psoas abscess did not recurred.The kyphosis was corrected obviously and the loss of correction was not significant.Conclusions The two surgeries have good clinical effects in the short segment thoracic and lumbar tuberculosis.The posterior surgery alone has less operative trauma.It is proper for the patients who have bilateral psoas abscess or can′t tolerate the anterior surgery.