后路经单侧椎弓根入路病灶清除植骨内固定重建胸腰椎结核脊柱前中柱功能的疗效

doi:10.3969/j.issn.1009-976X.2024.01.009

摘要/Abstract

摘要： 目的研究后路经单侧椎弓根入路病灶清除植骨内固定重建胸腰椎结核脊柱前中柱功能的疗效。方法选取2018年1月~2022年4月河源市人民医院收治的53例胸腰椎结核患者为观察组,采用后路经单侧椎弓根入路病灶清除植骨内固定治疗。选取2014年1月~2017年12月我院收治的52例胸腰椎结核患者为对照组,采用传统后路病灶清除植骨内固定治疗,比较两组术中及术后指标、红细胞沉降率（ESR）、C反应蛋白（CRP）、病变节段矢状面Cobb角、Cobb角丢失率、数字疼痛（NRS）评分、Oswestry功能障碍指数、美国脊柱损伤协会神经功能（ASIA）分级及并发症发生情况。结果观察组术后引流量低于对照组（P<0.05）;两组术后末次随访ESR、CRP均降低（P<0.05）;术后末次随访两组病变节段矢状面Cobb角及Oswestry功能障碍指数较术前下降（P<0.05）,观察组术后cobb角丢失率低于对照组（P<0.05）,术后末次随访两组NRS评分降低且观察组低于对照组（P<0.05）;术后末次随访观察组C-D级比例低于对照组（P<0.05）,观察组E级比例高于对照组（P<0.05）;两组胸腔积液、切口感染、肋间神经痛及脑脊液漏并发症总发生率比较,无统计学差异（P>0.05）。结论采用后路经单侧椎弓根入路病灶清除植骨内固定治疗胸腰椎结核患者,患者术后引流量更少,术后cobb角丢失率及疼痛程度更低,脊柱前中柱功能重建效果更好,神经功能恢复更好。

关键词: 胸腰椎结核, 后路经单侧椎, 弓根入路

Abstract: Objective To study the efficacy of anterior spinal column function in the reconstruction of thoracolumbar tuberculosis. Methods Fifty-three patients with thoracolumbar tuberculosis admitted to Heyuan People′s Hospital from January 2018 to April 2022 were selected as the observation group, and treated by posterior debridement via unilateral pedicle approach with bone grafting and internal fixation. Fifty-two patients with thoracolumbar tuberculosis admitted to our hospital from January 2014 to December 2017 were selected as the control group and treated with traditional posterior debridement with bone graft and internal fixation. The intraoperative and postoperative indicators, erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, Cobb angle, Cobb angle loss rate, digital pain （NRS） score, Oswestry dysfunction index, American Spine Injury Association Neurological Function （ASIA） grade and complications were compared between the two groups. Results The postoperative drainage volume of observation group was lower than that of control group （P<0.05）. At the last follow-up after surgery, ESR and CRP were decreased in both groups （P<0.05）. At the last postoperative follow-up, the Cobb Angle and Oswestry disability index in the sagittal plane of the lesion were decreased in both groups compared with those before surgery （P<0.05）, the cobb Angle loss rate in the observation group was lower than that in the control group （P<0.05）, the NRS score in the observation group was lower than that in the control group at the last postoperative follow-up （P<0.05）. The proportion of grade C-D in observation group was lower than that in control group （P<0.05）, and the proportion of grade E in observation group was higher than that in control group （P<0.05）. There were no significant differences in the total incidence of pleural effusion, incision infection, intercostal neuralgia and cerebrospinal fluid leakage between the two groups （P>0.05）. Conclusion Patients with thoracolumbar spinal tuberculosis have less postoperative drainage rate, lower postoperative cobb angle loss rate and lower pain degree, and better neurological function recovery.

Key words: thoracolumbar tuberculosis, posterior approach, unilateral pedicle approach

中图分类号:

R681.5

方磊, 陈鑫营, 易燕斌, 陈子华. 后路经单侧椎弓根入路病灶清除植骨内固定重建胸腰椎结核脊柱前中柱功能的疗效[J]. 岭南现代临床外科, 2024, 24(01): 59-64.

FANG Lei, CHEN Xin-ying, YI Yan-bin, CHEN Zi-hua. Efficacy of reconstructing anterior spinal column function in thoracolumbar tuberculosis by lesion removal via unilateral pedicle approach[J]. Lingnan Modern Clinics In Surgery, 2024, 24(01): 59-64.

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