一期前路、后路、前后路联合病灶清除治疗脊柱结核的临床效果

秦英 梁胜根 陈忠羡

【摘要】 目的：分析一期前路、后路、前后路联合手术治疗脊柱结核的临床效果。方法：回顾性分析2005年1月-2018年1月本科手术治疗的130例脊柱结核患者的资料，按照手术入路的不同分为前路组62例，后路组48例，前后路联合组20例，比较三组患者住院时间、手术时间、术中出血量、Cobb角矫正率、并发症的发生率、骨融合率之间的差异。结果：前后路联合组的住院时间、手术时间、出血量多于前路组及后路组（P<0.05）;前路组的出血量多于后路组，后路组及前后路联合组在后凸Cobb角矫正率方面优于前路，前路及前后路联合组的并发症发生率高于后路组（P<0.05）;融合率各组间比较差异无统计学意义（P>0.05）。结论：前路及后路手术均能有效治疗脊柱结核，但后路手术相对于前路手术出血量更少，并发症发生率更低，后凸畸形矫正率更高。

【关键词】 脊柱结核; 病灶清除; 内固定; 手术入路

【Abstract】 Objective：To compare the clinical effect of anterior alone，posterior alone and anterior combined with posterior treatment on spinal tuberculosis.Method：This study retrospectively reviewed 130 patients  treated in our department from Jan 2005 to Jan 2018.According to operation approach，they were separated into three groups.The anterior group undergoing anterior debridement with internal fixation（n=62）.The posterior group undergoing posterior debridement with internal fixation（n=48）.The anterior combined with posterior group undergoing anterior debridement combined with posterior internal fixation（n=20）.The hospitalization days，operation time，intraoperative blood loss ，Cobbs angle correction，complication rate，fusion rate were recorded and evaluated among three groups.Result：The hospitalization days，operation time and blood loss in anterior combined with posterior group were much more than those of anterior group and posterior group（P<0.05）.The operation blood loss in anterior group was higher than that of posterior group（P<0.05）.The Cobbs angle correction in posterior group and anterior combined with posterior group were more effective than that of anterior group，the difference was statistically significant（P<0.05）.The complication rate in anterior group and anterior combined with posterior group were higher than that of posterior group，the difference was statistically significant（P<0.05）.There were no significant differences in fusion rate between the groups（P>0.05）.Conclusion：Both anterior approach and posterior approach are effective on treatment of spinal tuberculosis.Posterior approach treatment is better than anterior approach for less blood loss，more effective Cobbs angle correction and less complications.

【Key words】 Spinal tuberculosis; Debridement; Internal fixation; Surgical approach

First-authors address：Sun Yat-sen University Affiliated Jiangmen Hospital，Jiangmen 529030，China

doi：10.3969/j.issn.1674-4985.2019.16.034

前路病灶清除術治疗脊柱结核具有减压直接、植骨面积大、融合率高等优点[1]。近年来部分学者尝试从后路进行病灶清除，获得了良好的临床效果[2]。而对于特殊类型的脊柱结核，有学者建议采取前后路联合的方法进行病灶清除[3]。本文收集本科开展的130例脊柱结核病灶清除手术患者，分析各种手术方式的临床效果。