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中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (04) : 231 -236. doi: 10.3877/cma.j.issn.2096-0263.2022.04.007

脊柱专题

不同手术入路治疗老年胸腰椎结核的手术疗效分析
叶曙明, 孙健, 汪祥, 荆珏华()   
  1. 230601 合肥,安徽医科大学第二附属医院骨科
  • 收稿日期:2022-03-23 出版日期:2022-08-05
  • 通信作者: 荆珏华
  • 基金资助:
    安徽省高校自然科学研究项目(KJ2020A0182); 合肥市自然科学研究基金项目(2021010); 安徽医科大学第二附属医院临床研究培育计划项目(2020LCYB07)

Clinical therapeutic effects comparison of two different surgical approaches in the treatment of thoracolumbar spinal tuberculosis in elderly patients

Shuming Ye, Jian Sun, Xiang Wang, Juehua Jing()   

  1. Department of Orthopaedics Surgery, the second hospital of Anhui Medical University, Hefei 230601, China
  • Received:2022-03-23 Published:2022-08-05
  • Corresponding author: Juehua Jing
引用本文:

叶曙明, 孙健, 汪祥, 荆珏华. 不同手术入路治疗老年胸腰椎结核的手术疗效分析[J/OL]. 中华老年骨科与康复电子杂志, 2022, 08(04): 231-236.

Shuming Ye, Jian Sun, Xiang Wang, Juehua Jing. Clinical therapeutic effects comparison of two different surgical approaches in the treatment of thoracolumbar spinal tuberculosis in elderly patients[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(04): 231-236.

目的

探讨两种不同手术入路治疗老年胸腰椎结核的临床疗效。

方法

回顾性分析2013年01月至2019年12月安徽医科大学第二附属医院脊柱外科收治的124例老年胸腰椎结核患者的临床资料,其中男性70例,女性54例;年龄(64.7±5.2)岁。按照手术入路分组:前路入路手术组63例;后路入路手术组61例。比较两组的手术时间、术中出血量、住院时间、术前和术后的Cobb角、红细胞沉降率(ESR)、C反应蛋白(CRP)、疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)等指标的差异。

结果

124例患者获得完整随访,随访时间12~24个月,平均为(16.2±2.6)个月。前路入路手术组和后路入路手术组的手术时间、住院时间和术中出血量比较,差异无统计学意义(P>0.05);末次随访时,前路入路手术治疗组患者术后Cobb角度[(17.1±3.5)°]大于后路手术入路组[(13.4±4.2)°,P<0.05];两组患者术前、末次随访ESR、CRP、VAS评分、ODI指数比较,差异有统计学意义(P<0.05)。末次随访时,所有患者术后脊柱结核病灶未见复发,未发现感染、下肢深静脉血栓、骨不愈合或延迟愈合等并发症。

结论

两种不同手术入路治疗老年人胸腰椎结核均取得了良好疗效,但是后路入路手术对于脊柱后凸畸形的矫正效果更好。

Objective

To investigate the clinical outcome of two different surgical approaches in the treatment of thoracolumbar spinal tuberculosis in elderly patients.

Methods

A retrospective study was performed on 124 patients with thoracolumbar spinal tuberculosis who underwent two different surgical approaches in the second hospital of Anhui Medical University form January 2013 to December 2019. Patients were divided into two groups according to the different surgical approaches: Anterior approach group (n=63) were treated by anterior surgical approach, and posterior approach group (n=61) were treated by posterior surgical approach. Meanwhile, the operation time, intra-operative blood loss, hospitalization time, Cobb'angle, ESR, CRP, VAS, and ODI were compared between the two groups.

Results

There was no significant difference between the two groups in terms of operation time, intra-operative blood loss and hospitalization time (P>0.05), and there was significant difference between the two groups in ESR, CRP, VAS and ODI per-operatively and final follow-up. At the final follow-up, the post-operative Cobb's angle of anterior approach group was higher than that of posterior approach group showing significantly difference (P<0.05). No complications of recurrence of spinal tuberculosis, and no complications of infection, deep vein thrombosis, nonunion or delayed union was observed.

Conclusion

These two different surgical approaches for thoracolumbar spinal tuberculosis showed good clinical outcome in elderly patients, and the posterior approach is better for the correction of kyphosis.

表1 两组老年胸腰椎结核患者的一般资料比较
图1 脊柱侧弯Cobb角示意图。X线表示头侧端椎上缘的垂线,y线表示尾侧端椎下缘垂线,β角即为Cobb角
图7~11 患者女性,68岁,L1、L2椎体结核,仅行单纯后路脊柱内固定治疗L1、L2椎体结核。图7~8 术前X线片、CT显示L1~2椎间隙被侵蚀,L1椎体下部、L2椎体上部破坏。图9 术前T2加权MRI显示L1~2节段马尾神经受压,受累的椎体、椎间脓肿和椎旁软组织高信号影。图10 术后1周腰椎侧位X线片显示仅予以脊柱后路内固定未行病灶彻底清创。图11 术后19个月腰椎侧位X线片显示腰椎结核治愈,内固定位置好,未出现松动
表2 两组老年胸腰椎结核患者的手术时间、术中出血量和住院时间(±s
表3 不同手术入路老年胸腰椎结核患者术前术后影像学测量及临床疗效评价指标比较(±s
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