前路固定与后路固定对脊柱结核一期病灶清除植骨融合术的疗效影响

目的探讨和对比前路固定与后路固定一期病灶清除植骨融合术治疗脊柱结核的疗效。方法将2006年10月至2012年10月收治的80例脊柱结核患者随机分为A组和B组。A组40例,采用前路固定;B组40例,采用后路固定。根据患者病变侵犯椎体数目分成不同亚组。单个椎体者为A1组和B1组,多个椎体者为A2组和B2组。根据椎体后凸角度在A2组和B2组分成不同亚组,后凸角度小于60°为α组,≥60°为β组。结果 A1组手术时间和出血量低于B1组,差异有统计学意义（P〈0.05）。A2β组术后后凸角、畸形矫正率与B2β组相比差异有统计学意义（P〈0.05）。B2组并发症发病率低于A2组,差异有统计学意义（P〈0.05）。结论前路固定一期病灶清除植骨融合术治疗累及单个椎体的患者时具有可以减少手术时间和手术损伤;后路固定一期病灶清除植骨融合术适用于累及多个椎体以及后凸角度较大的脊柱结核患者。

Effect of anterior and posterior internal fixation on one-stage radical debridement and bone graft fusion in spinal tuber- culosis

Objective To investigate and compare the efficacy of anterior and posterior internal fixation one- stage radical debridement and bone graft fusion in treating spinal tuberculosis. Methods 80 cases of spinal tuberculo- sis treated from October 2006 to October 2012 were selected and randomly divided into the group A and B. The group A（40 cases） used anterior internal fixation and the group B（40 cases） used posterior internal fixation. The different subgroups were divided according to the number of injured vertebral body. The cases of single vertebral body were taken as the group A1 and B1, while the cases of multiple vertebral bodies were taken as the group A2 and B2. The subgroup A2 and B2 were redivided into the different subgroups according to the kyphosis angle of vertebral body. The cases with the kyphosis angle〈60° were as the group α,which 〉60° as the group β. Results The operative time and blood loss of the group A1 were significantly lower than those of the group B1, the difference had statistical sig- nificance（P〈0.05）. The correction rate of postoperative kyphosis angle and the deformity in the group A2β bad sta- tistical significance compared with the group B2β （P〈0.05）. The complication incidence rate of the group B2 was sig- nificantly lower than that of the group A2 with statistical difference（P〈0.05）. Conclusion Anterior internal fixation one-stage radical debridement and bone graft fusion in treating spinal tuberculosis with injured single vertebral body can reduce the surgical time and surgical injury; posterior internal fixation one-stage radical debridement and bone graft fusion is suitable for the spinal tuberculosis with injured multiple vertebral bodies and large kyphosis angle.