摘要
[目的]研究胸腔镜辅助下小切口技术前路病灶清除加植骨内固定治疗胸椎结核的临床疗效。[方法]分析2004年6月~2009年6月手术治疗的胸椎结核病人48例,男23例,女25例。按手术方式分为A组（开放手术组）和B组（胸腔镜辅助手术组）,记录两组患者术中、术后出血量及手术时间。随访两组患者术后胸背疼痛、脊柱功能及胸椎后凸角矫正改善情况,并进行比较。[结果]A、B两组术中、术后出血量及手术时间组间分别比较差异有统计学意义（P〈0.05）。48例患者经随访12~48个月（平均20个月）,两组术后VAS、ODI及后凸角较术前明显改善（P〈0.05）;两组术后VAS、ODI及后凸角改善率组间分别比较差异无统计学意义（P〉0.05）,但是术后1周VAS改善B组较A组明显（P〈0.05）。A组并发症8例（38.1%）与B组5例（18.5%）比较差异有统计学意义（P〈0.05）。[结论]胸腔镜辅助下小切口前路病灶清除植骨内固定能有效地清除胸椎结核病灶,稳定脊柱,熟悉胸椎前方解剖结构,掌握胸腔镜操作技术及手术者之间默契配合是手术成功的关键。
[Objective]To study The clinical effect of anterior approach focus clearance,fusion and internal fixation on thoracic vertebral tuberculosis by video-assisted thoracoscopy combined with minimal incision procedures. [Methods]From June 2004 to June 2009,48 patients who underwent operation treatment of thoracic vertebral tuberculosis,including 23 males and 25 females,were restrospectively reviewed.All patients were classified into Group A（open approach） and Group B（minimal incision procedures）.The intraoperative blood loss,blood drainage and operative time were recorded,respectively.The follow-up results of Groups A and B for the back pain,spinal functions and posterior angulation were compared.[Results]The two groups had significant differences with repect to intraoperative blood loss,blood drainage and operative time（P0.05）.All the 48 patients were followed up from 12 to 48 months（average,20 months）.The VAS,ODI and posterior angulation of both groups were improved after operantion.At the final follow-up,there was no difference in VAS,ODI and posterior angulation between the two groups（P0.05）,but the VAS in Group B was superior than in Group A at one week after operation（P0.05）.The incidence rates of complication in Groups A and B were 38.1%（n=8） and 18.5%（n=5）,and there was significant difference in complication incidence（P0.05）.[Conclusion]Anterior approach focus clearance,fusion and internal fixation for thoracic vertebral tuberculosis by video-assisted thoracoscopy combined with minimal incision procedures is an effective approach to clear focus and restore spinal stability.Understanging of the anterior anatomy of thoracic vertebrae and mastering the skill of video-assisted thoracoscopy are helpful to ensure the successful surgery.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2011年第3期184-187,共4页
Orthopedic Journal of China
关键词
胸腔镜
胸椎结核
前路
疗效研究
video-assisted thoracoscopy
thoracic vertebral tuberculosis
anterior approach
clinical effect studies
