单纯后路病灶清除植骨融合内固定术治疗脊柱结核

目的分析后路病灶清除植骨融合内固定术治疗脊柱结核的临床疗效。方法对60例脊柱结核患者进行常规四联抗结核化疗,手术方式为后路病灶清除植骨内固定。采用VAS评分、ODI和Frankel分级对患者进行术前术后评估。结果手术时间4~8(4.30±2.60)h。全部患者手术成功,未出现术后结核复发、内固定断裂等情况。患者均获得12个月随访。术后12个月,VAS评分由术前7.97分±0.69分改善至1.18分±0.83分(P0.05);ODI由术前43.58±2.08改善至9.63±1.66(P0.05)。术后6个月,Cobb角:胸椎由术前35.00°±2.83°改善至20.70°±2.26°(P0.05),胸腰段由术前20.75°±2.22°改善至5.42°±1.78°(P0.05),腰椎由术前的27.00°±1.41°改善至46.50°±1.29°(P0.05),术后12个月复查各角度均有部分丢失(P0.05)。Frankel分级:A级3例改善至B级1例,2例无改善;B级5例改善至C级1例、D级1例,3例无改善;C级7例改善至D级3例、E级2例,2例无改善;D级11例改善至E级8例,3例无改善;E级34例无加重。1例患者合并术后窦道形成,3个月后愈合。结论单纯后路手术能在有效清除病灶的基础上减少手术时间,降低术后并发症的发生率。

Spinal tuberculosis treatment via isolated posterior approach for focal debridement and inter-nal fixation of bone grafting fusion

Objective To analyze the clinical efficacy of spinal tuberculosis treatment via posterior approach for focal debridement and internal fixation of bone grafting fusion. Methods Sixty patients with spinal tuberculosis were trea-ted with conventional quadruple antituberculosis chemotherapy, and the surgery was performed isolated posterior ap-proach for focal debridement and internal fixation of bone grafting fusion. VAS and ODI and Frankel classification were used to evaluate the patients of preoperative and postoperative condition. Results With the operation time of 4~8(4. 30 ± 2. 60)h. All patients′surgery had been successful and without cases like tuberculosis recurrence, inter-nal fixation broken nails, broken rods, and so on. All the patients had received a 12-month follow-up. Twelve months postoperation,the VAS had reduced from the preoperative level of 7. 97 ± 0. 69 to the postoperative level of 1. 18 ± 0. 83(P<0. 05);the ODI had reduced from the preoperative level of 43. 58 ± 2. 08 to the postoperative level of 9. 63 ± 1. 66(P<0. 05). Six months postoperation,the Cobb angle:thoracic vertebra had improved from the preopera-tive level of 35.00° ±2.83° to the postoperative level of 20.70° ±2.26°(P<0.05); thoracolumbar had improved from the preoperative level of 20. 75° ± 2. 22° to the postoperative level of 5. 42° ± 1. 78°(P<0. 05);lumbar had im-proved from the preoperative level of 27.00° ±1.41° to the postoperative level of 46.50° ±1.29°(P<0.05). All angles were partly missed in the 12 months review after surgery(P<0. 05). Frankel classification:3 cases of A class improved to 1 of class B and 2 remained the same;5 cases of B class improved to 1 of C class, 1 of D class, and 3 remained the same;7 cases of C class improved to 3 of D class, 2 of E class, and 2 remained the same;11 cases of D class improved to 8 of E classes and 3 remained the same;34 cases of E class; no cases of aggravation. 1 case formed sinus and healed after 3 months. Conclusions Isolated posterior approach can not only shorten the surgery time on the base of debriding focus effectively but also decrease the complication incidence rate.