前、后路内固定手术治疗胸腰段脊柱结核的对比研究

目的分析对脊柱结核（胸腰段）患者进行手术治疗的理想化方案。方法对本院2007年10月～2011年10月收治的100例脊柱结核（胸腰段）患者中65例信息进行回顾性分析。其中65例患者采取病灶清除并植骨融合的内固定术进行治疗。在A组中30例患者于一期前路行病灶清除并植骨融合后再予以钉棒矫形的内固定术;在B组中35例患者于一期后路行钉棒矫形后再予以内固定术,之后行前路病灶的清除并植骨融合术。两组又分成累及单个椎体组（即A1组与B1组）和累及多个椎体组（即A2组与B2组）。再对A1组与B1组,以及A2组与B2组其手术时间与术中的出血量及其矫形率进行对比。结果其中,A1组的手术时间与术中的出血量显著低于B1组（P〈0.05）;而B2组的矫形率与稳定性均优于A2组（P〈0.05）。结论脊柱结核（胸腰段）累及单个椎体时,于一期前路行病灶清除并植骨融合,之后行钉棒矫形的内固定术治疗,为理想化方案;而累及多个椎体,特别脊柱后凸的角度偏大时,于一期后路行钉棒矫形后再予以内固定术,之后行前路病灶的清除并植骨融合术则为理想化方案。

Comparative study on anterior and posterior fixation in the treatment of lumbar spinal tuberculosis

Objective To analyse the ideal surgical treatment for spinal tuberculosis(thoracolumbar).Methods One hundred cases of spinal tuberculosis(thoracolumbar) from October 2007 to October 2011 in our hospital were retrospectively analyzed.Sixty five patients were taken to debridement and fusion with internal fixation for treatment.Thirty patients in group A were given screw-rod fixation of orthopedic surgery after anterior debridement and fusion line;35 patients in group B were given fixation of orthopedic surgery after the removal of anterior lesions and bone grafting.These two groups were respectively divided into two groups involving a single vertebral body(group A1 and B1),and involving multiple vertebral group(group A2 and B2),the surgery time and the intraoperative blood loss,the correction rate between group A1 and B1,group A2 and B2 were compared.Results The operation time and intraoperative bleeding of group A1 was significantly lower than group B1(P < 0.05);and the correction rate and stability of group B2 were better than group A2.Conclusion Screw-rod fixation of orthopedic surgery after anterior debridement and fusion line is the ideal solution while spinal tuberculosis(thoracolumbar) involving a single vertebral body,fixation of orthopedic surgery after the removal of anterior lesions and bone grafting is the ideal solution while spinal tuberculosis involving multiple vertebraes,especially when the kyphosis angle is too large.