三种腰椎结核手术方式的比较研究

目的比较不同手术方式治疗腰椎结核的疗效。方法回顾分析2003-02-2010-08收治的88例腰椎结核患者,其中23例行一期前路病灶清除植骨融合内固定术,简称前路手术组(A组);25例行一期前路病灶清除植骨融合后路内固定术,简称前后路联合手术组(B组);40例行一期后路病灶清除植骨融合内固定术,简称后路手术组(C组)。随访8~24个月,平均15个月。通过记录和观察三组患者的手术时间、术中出血量、住院天数及手术前后的Frankel分级、Cobb’s角、ESR值变化情况,进行相互比较分析。结果所有病例切口均I期愈合,无严重并发症发生。在平均手术时间、平均术中出血、平均住院天数上,A/C、B/C组比较有显著性差异(P<0.01),A/B组比较无明显差异(P>0.05)。三组术前术后的Frankel分级、Cobb’s角及ESR值变化程度比较无明显差异(P>0.05)。结论在严格把握手术适应证的基础上,一期后路病灶清除植骨融合内固定术治疗腰椎结核与前路及前后路联合术式均可获得较好的治疗效果,但后路术式手术时间短、出血少、住院时间短,是一种安全可行、更方便的手术方式。

Comparative study on the results of three surgical methods for tuberculosis of lumbar spine

Objective To compare the effect of three surgical methods for tuberculosis of lumbar spine.Methods 88 cases of lumbar tuberculosis were retrospectively studied from February 2003 to August 2010.Of them,23 cases received anterior debridement,bone graft fusion and internal fixation at one-stage(group A),other 25 cases experienced anterior debridement and bone graft plus posterior instrumentation(group B)and another 40 cases underwent posterior debridement,bone graft fusion and internal fixation at one-stage(group.All cases were followed up for 8-24 months(average 15 months).The operative time,blood loss,hospitalization,Frankel grade and Cobb′s angle、ESR before and after surgery between each group were reviewed and compared.Results The wound primary healing achieved in all patients,no severe complications were found in three groups.On the average operative time、the average blood loss and the average hospitalization;it showed significant difference between A,C groups and B,C groups(P<0.01),but no significant difference in A,B groups(P>0.05).No significant difference was noted with respect to Frankel grade,Cobb’s angle and ESR among three groups(P>0.05).Conclusion Base on strictly control operative indication,operation of lumbar tuberculosis by one-stage posterior debridement,bone graft fusion and internal fixation、the surgery combined anterior and posterior and anterior surgery can all get good curative effect,but posterior surgery has the advantages of less operative time,less bloodloss and shorter hospitalization.So it is a secure,viable,raletive convenient surgery.