背景:随着后路手术的广泛使用,越来越多的外科医师选择后路手术治疗胸腰椎结核。但其他人仍然认为前路手术更有利于根除病变,更容易放置较大的骨块进行植骨融合。我们比较了前后手术入路的临床和放射学结果,并提出了我们的观点。
方法:本研究纳入2010年1月至2018年6月孙逸仙纪念医院收治的胸腰椎结核患者52例。所有病例均接受彻底清创,神经减压术,椎间植骨融合内固定。病例分为前路组(24例)和后路组(28例)。采用统计学分析比较临床疗效,放射学结果,并发症和其他相关信息。
结果:前组和后组患者均获随访,平均27.4和22.3个月,分别。术前组间差异无统计学意义,术后和末次随访VAS评分,局部后凸的ASIA等级和Cobb角。此外,神经功能改善无统计学差异,后凸矫正的损失,并发症的总发生率,手术时间,术中出血量和住院时间比较差异无统计学意义(P>0.05)。但是脊柱后凸有更大的矫正,早期的骨融合,伤口愈合不良的发生率较低,前路组对正常脊柱的干扰较少,内固定耗材和医疗费用较少(P<0.05)。
结论:胸腰椎结核前路和后路均可行。而对于单个病变局限在脊柱前柱和中柱而没有严重后凸的胸腰椎结核患者,前路手术在后凸矫正中可能具有更大的优势,骨融合,伤口愈合,保护正常脊柱,以及医疗耗材和成本。
BACKGROUND: With the widespread use of the
posterior surgery, more and more surgeons chose
posterior surgery to treat thoracic and lumbar tuberculosis. But others still believed that the anterior surgery is more conducive to eradicating the lesions, and easier to place larger bone pieces for bone graft fusion. We compared the clinical and radiological outcomes of anterior and
posterior surgical approaches and presented our views.
METHODS: This study included 52 thoracic and lumbar tuberculosis patients at Sun Yat-sen Memorial Hospital from January 2010 to June 2018. All cases underwent radical debridement, nerve decompression, intervertebral bone graft fusion and internal fixation. Cases were divided into anterior group (24 cases) and
posterior group (28 cases). Statistical analysis was used to compare the clinical effectiveness, radiological outcomes, complications and other related information.
RESULTS: Patients in the anterior group and the
posterior group were followed up for an average of 27.4 and 22.3 months, respectively. There were no statistically significant differences between groups in the preoperative, postoperative and last follow-up VAS score, ASIA grade and Cobb angle of local kyphosis. Moreover, there were no statistically significant differences in the improvement of neurological function, loss of kyphotic correction, total incidence of complications, operative time, intraoperative blood loss and hospital stay between the two groups (P > 0.05). But there was greater correction of kyphosis, earlier bone fusion, lower incidence of poor wound healing, less interference with the normal spine and less internal fixation consumables and medical cost in the anterior group (P < 0.05).
CONCLUSIONS: Both anterior and
posterior approaches are feasible for thoracic and lumbar tuberculosis. While for thoracic and lumbar tuberculosis patients with a single lesion limited in the anterior and middle columns of the spine without severe kyphosis, the anterior approach surgery may have greater advantages in kyphosis correction, bone fusion, wound healing, protection of the normal spine, and medical consumables and cost.