Ⅰ期经后路病灶清除植骨融合内固定术治疗胸腰椎结核的疗效观察

【目的】探讨I期后路病灶清除、椎体间植骨融合内固定治疗胸腰椎结核的临床疗效及手术指征。【方法】收集湖南省人民医院2003年1月至2008年12月共收治的胸腰椎结核手术患者资料，根据其病情其中30例I期后路行病灶清除＋植骨融合＋内固定术（A组）；另30例行后路内固定＋前路病灶清除＋植骨融合术（B组），比较两组的手术时间、出血量、住院时间、术后1～18个月ESR、cobb角、骨融合、ASIA分级、JOA分级及术后复发等情况。【结果】A组出血量及手术时间与B组比较明显减少有统计学差异（P〈O．05），两组间临床效果（术后ESR、cobb角、骨融合、ASIA分级、JOA分级及术后复发等）及住院时间比较无统计学差异（P〉0．05）【结论】I期后路病灶清除、椎间植骨融合内固定术较后路固定前路病灶清除植骨融合手术具有出血少、手术时间短、创伤小等特点。但植骨融合时间较长，病变部位暴露不充分，椎体前方的病灶清除创伤较大且不易清除，应严格掌握其手术指征。

Observation on the Efficacy of One-stage Posterior Intervertebral Debridement, Bone Graft Fusion and Internal Fixation for the Treatment of Thoracic and Lumbar Tuberculosis

Objective]To retrospectively study the surgery of patients with thoracic and lumbar tuberculosis, and ex plore the clinical efficacy and indications of onestage posterior intervertebral debridement, hone graft fusion and internal fixation for the treatment of thoracic and lumbar tuberculosis compared with posterior fixation, anterior debridement and hone graft fusion. Methods] Clinical data of patients with thoracic and lumbar tuberculosis undergoing the operation in our hospital from Jan. 2003 to Dec. 2008 were collected. According to the patient＇s condition, 30 cases underwent one stage posterior intervertebral debridement, bone graft fusion and internal fixation（group A） and other 30 cases underwent posterior internal fixation, anterior radical eradication and hone graft fusion（group B）. The operation time, blood loss, hospital stay, ESR at 1 ~ 18 months after surgery, cobb angle, hone fusion, ASIA grade, JOA classification and postop erative recurrence were compared between two groups. Results]There were significant differences in blood loss and opera tion time between two groups（ P d0. 05）, but there was no significant difference in clinical efficacy（postoperative ESR, cobb angle, hone fusion, ASIA grade, JOA classification and the recurrence）and hospital stay between two groups（ P 0.05）. Conclusion]Compared with posterior internal fixation, anterior radical eradication and bone graft fusion, one stage posterior intervertebral debridement, bone graft fusion and internal fixation has advantages such as less blood loss, short operation time and little injury. But onestage posterior intervertebral debridement, bone graft fusion and internal fixation has the disadvantages such as the longer time of bone graft and fusion, insufficient exposure of lesion region, lar ger trauma caused by the debridement of the anterior lesion of vertebral body which is not easy to be removed, so the sur gical indications should be strictly controlled.