胸腰椎结核前路与后路病灶清除融合固定比较（开放获取）

Anterior versus posterior approach debridement and instrumented fusion for thoracolumbar tuberculosis

摘要:

[目的] 比较前路与后路手术治疗胸腰椎结核的临床效果。[方法] 回顾性分析本院2015 年1 月—2020 年10 月手术治疗的103 例胸腰椎脊柱结核患者的临床资料。根据医患沟通结果，39 例采用前路手术（前路组），64 例采用后路手术（后路组），比较两组围手术期情况、随访及影像资料。[结果] 所有患者均顺利完成手术，前路组手术时间[(136.7±19.2) min vs(108.7±15.6) min, P＜0.05]、切口总长度[(23.0±3.8) cm vs (14.6±3.5) cm, P＜0.05] 、术中出血量[(558.7±42.7) ml vs (408.8±35.8) ml, P＜0.05] 均显著大于后路组，术中透视次数[(3.5±1.5) 次vs (6.7±2.1) 次, P＜0.05] 显著少于后路组。前路组早期并发症发生率显著高于后路组(15.4% vs 6.3%, P＜0.05)。随访时间平均（29.6±10.4） 个月，两组临床愈合时间的差异无统计学意义（P＞0.05）。随时间推移，两组患者VAS、ODI 、JOA 评分均显著改善（P＜0.05），ASIA 评级无显著变化（P＞0.05），相应时间点，两组VAS、JOA、ODI 评分及ASIA 评级的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时，两组患者椎管面积、后凸Cobb角、病灶活动情况均显著改善（P＜0.05），相应时间点，两组间椎管面积、后凸Cobb 角、病灶活动情况的差异均无统计学意义（P＞0.05）。[结论] 前路手术和后路手术均为胸腰椎结核有效的治疗方式选择，后路手术创伤相对较小，具有一定的优势。

Abstract:

[Objective] To compare the clinical outcomes of anterior versus posterior approach debridement and instrumented fusionsfor thoracolumbar tuberculosis. [Methods] A retrospective study was performed on 103 patients who received surgical treatment for thoraco-lumbar tuberculosis in our hospital from January 2015 to October 2020. According to doctor-patient communication, 39 patients underwentanterior-approach surgery (the anterior group), while the remaining 64 cases underwent posterior-approach surgery (the posterior group).The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding sur-gical procedures performed successfully, the anterior group proved significantly greater than the posterior group in terms of operation time[(136.7±19.2) min vs (108.7±15.6) min, P＜0.05], the total incision length [(23.0±3.8) cm vs (14.6±3.5) cm, P＜0.05], intraoperative blood loss[(558.7±42.7) ml vs (408.8±35.8) ml, P＜0.05], regardless of the fact thar the former had significantly less intraoperative fluoroscopy timesthan the latter [(3.5±1.5) times vs (6.7±2.1) times, P＜0.05]. In addition, the incidence of early complications in the anterior group was signifi-cantly higher than that in the posterior group (15.4% vs 6.3%, P＜0.05). The follow-up period lasted for a mean of (29.6±10.4) months , andthere was no significant difference in clinical healing time between the two groups (P＞0.05). The VAS, ODI and JOA scores were significant-ly improved in 2 groups (P＜0.05), while ASIA grade for neurological function remained unchanged over time in both groups (P＞0.05), whichwere not statistically significant between the two groups at any time points accordingly (P＞0.05). With respect of imaging, the spinal canal ar-ea, local kyphotic Cobb angle and lesion state were significantly improved in both groups at the last follow-up compared with those preopera-tively (P＜0.05), whereas all which were not statistically significant between the two groups at any time points accordingly (P＞0.05). [Conclu-sion] Both anterior and posterior debridement and instrumented fusions are effective options for the treatment of thoracolumbar tuberculosis,by comparison, the posterior surgery has certain advantages of less trauma over the anterior counterpart.