Effect observation of focal debridement and internal fixation of bone graft under different approaches in treatment of patients with single-segment lumbar tuberculosis
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摘要: 目的 探讨不同入路下病灶清除植骨内固定术治疗单节段腰椎结核的近远期疗效。 方法 将54例单节段腰椎结核患者根据手术入路方式分为后路径组29例与前路径组25例,其中后路径组行I期后路病灶清除植骨内固定术治疗,前路径组行I期前路病灶清除植骨内固定术治疗。比较2组患者手术时间、术中出血量、住院时间; 比较2组患者手术前后红细胞沉降率(ESR)、C反应蛋白(CRP)水平; 比较2组患者术前及术后12个月腰痛视觉模拟评分(VAS)、Oswestry指数(ODI); 比较2组患者术后12个月并发症发生情况。 结果 后路径组手术时间、术中出血量及住院时间显著优于前路径组(P<0.05)。2组患者术后ESR及CRP水平显著降低(P<0.05), 且后路径组ESR及CRP水平显著低于前路径组(P<0.05)。2组患者术后VAS评分及ODI评分均显著降低(P<0.05), 且后路径组VAS、ODI评分显著低于前路径组(P<0.05)。后路径组术后并发症发生率为10.34%, 显著低于前路径组的32.00%(P<0.05)。 结论 后路入清除植骨内固定术治疗单节段腰椎结核安全、有效,可以有效缩短手术时间,减少术中出血量及降低术后并发症发生率,提高患者近远期疗效。Abstract: Objective To explore the short-term and long-term effect of focal debridement and internal fixation of bone graft under different approaches in treatment of patients with single-segment lumbar tuberculosis. Methods A total of 54 patients with single-segment lumbar tuberculosis were divided into posterior approach group(n=29)and anterior approach group(n=25)according to different surgical approaches. The posterior approach group was treated with phase Ⅰ debridement and internal fixation of bone graft under posterior approach, while anterior approach group was treated with phase Ⅰ debridement and internal fixation of bone graft under anterior approach. The operation time, intra-operative bleeding volume and hospitalization time were compared between two groups. The erythrocyte sedimentation rates(ESR)and C reactive protein(CRP)level before and after operation were compared. The Visual Analogue Score(VAS)and Oswestry Index(ODI)of lumbago before operation and 12 months after operation were compared between the two groups. The incidence of complications at 12 months after operation were compared between two groups. Results The operation time, intra-operative hemorrhage and hospitalization time in the posterior approach group were significantly better than those in the anterior approach group(P<0.05). The levels of ESR and CRP in both groups decreased significantly(P<0.05), and the levels of ESR and CRP in the posterior - approach group were significantly lower than those in the anterior pathway group(P<0.05). The VAS and ODI scores in both groups significantly reduced after treatment(P<0.05), and the VAS and ODI scores of the posterior approach group were significantly lower than those of the anterior approach group(P<0.05). The incidence of postoperative complications in the posterior approach group was 10.34%, which was significantly lower than 32.00% in the anterior approach group(P<0.05). Conclusion Focal debridement and internal fixation of bone graft under posterior approach is effective and safe in treatment of patients with single-segment lumbar tuberculosis, which can effectively shorten operation time, reduce intra-operative blood loss and incidence of postoperative complications, and effectively improve short-term and long-term curative effect.
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