1期后路经单侧入路病灶清除植骨内固定治疗多节段胸腰椎结核的临床研究

目的:探讨1期后路经单侧入路病灶清除植骨内固定治疗多节段胸腰椎结核的有效性和安全性.方法:回顾性分析32例多节段胸腰椎结核患者临床资料,所有患者均经1期后路经单侧入路病灶清除植骨内固定治疗.比较患者治疗前后疼痛视觉模拟评分(visual analogue scale,VAS)、Cobb角、Oswestry功能障碍指数(Oswestry disability index,ODI)、美国脊柱损伤协会(American Spinal Injury Association,ASIA)分级及钛网安置情况.结果:相较于术前,术后即刻、末次随访时患者VAS评分、Cobb角及ODI均显著改善(P<0.05);末次随访时患者VAS评分较术后即刻显著减少(P<0.05);术后即刻及末次随访时患者Cobb角、ODI比较无统计学差异(P>0.05).相较于术前,末次随访时患者ASIA分级显著改善(P<0.05).病变节段数≥6个者未安置钛网率显著高于病变节段数<6个者(P<0.05);中心病灶部位位于胸椎、腰椎、胸腰段者未安置钛网率比较无统计学差异(P>0.05).本组患者均获得随访,随访时间19-32个月,平均随访时间(25.6±4.1)个月.随访期间均未发现内固定物松动、断裂.病灶区植骨后均可达骨性融合.结论:采用1期后路经单侧入路病灶清除植骨内固定治疗多节段胸腰椎结核,可减轻患者疼痛,减少病椎高度矫正丢失,促进神经功能恢复,具有良好的有效性和安全性.

Effect of One-stage Posterior Unilateral Debridement with Bone Graft and Internal Fixation on Multiple Segments tThoracolumbar Tuberculosis

Objective:To evaluate the efficacy and safety of one一stage posterior unilateral debridement with bone graft and internal fixation on multiple segments thoracolumbar tuberculosis.Methods:The data of 32 cases with multiple segments thoracolumbar tuberculosis were retrospectively analyze.All patients were treated with one-stage posterior unilateral debridement with bone graft and internal fixation.The visual analogue scale(VAS)score,Cobb angle,Oswestry disability index(ODI),American spinal injury association(ASIA)grading and titanium mesh placement were compared between before and after surgery.Results:Compared with pre-operation,the VAS score,Cobb angle,ODI of immediate post-operation and last follow一up significantly improve(P<0.05).The VAS score of last follow-up significantly less than immediate post-operation(P<0.05).The Cobb angle and ODI of immediate post-operation and last follow一up were no statistical difference(P>0.05).Compared with pre-operation,the ASIA grading of last follow-up significantly improve(P<0.05).The rate of titanium mesh placement of patient with lesion segmentsM6 significantly more than patient with lesion segments<6(P<0.05).The rate of titanium mesh placement was no statistical difference between thoracic vertebra,lumbar vertebra and thoracolumbar(P>0.05).All patients were followed up for 19?32 months,with an average follow-up time was(25.6±4.1)months.No looseness and fracture were found during the follow一up period.Bone grafting in the lesion area can be achieved.Conclusion:Using one-stage posterior unilateral debridement with bone graft and internal fixation to treat with multiple segments thoracolumbar tuberculosis,can reduce pain,reduce vertebral height correction loss,promote nerve functional recovery,has good efficacy and safety.