摘要
目的:对比微创经椎间孔入路与传统后路手术治疗腰椎结核的临床疗效,评价微创经椎间孔入路治疗腰椎结核的安全性及有效性。方法:回顾性分析本院2012年10月-2013年3月收治的单节段腰椎结核患者73例,所有患者均为单节段病变,以腰痛为主,无神经压迫症状,死骨和脓肿范围不大。其中43例采用传统开放手术,30例采用微创手术,于围术期分别记录两组患者的手术时间、术中出血量及术后引流量,术后1、3、6和12月时采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)进行疗效评估,末次随访时记录并比较两组患者的融合率。结果:所有患者术后腰痛明显减轻,发热患者体温在2周内恢复正常。微创手术组的手术时间、术中出血量及术后引流量分别为240±30 min、520±50 m L和630±110 m L,均明显少于传统手术组的180±35 min、350±50 m L和320±80 m L(P<0.05)。在术前、术后1月、3月、6月、12月和末次随访时,微创手术组腰痛VAS评分分别为8.7±1.2分、4.5±1.1分、3.5±1.1分、2.0±1.4分、1.3±0.5分和1.2±0.5分,ODI评分分别为(77±6)%、(31±5)%、(23±8)%、(14±6)%、(8±4)%和(7±3)%;传统手术组VAS评分分别为8.5±1.1分、2.7±0.7分、2.1±0.6分、1.9±0.7分、1.1±0.4分和1.1±0.4分,ODI评分分别为(78±5)%、(23±6)%、(14±7)%、(12±5)%、(7±2)%和(7±2)%。其中,术后1个月和3个月,微创组腰痛VAS评分和ODI评分均明显低于开放组(P<0.05)。术后6个月、12个月和末次随访时,两组患者腰痛VAS评分和ODI评分差异无统计学意义(P>0.05)。末次随访时所有病例均获得骨性融合。结论:微创经椎间孔入路手术治疗单节段腰骶椎结核,可获得与传统后路手术相同的临床疗效,且手术时间短,术中出血量及术后引流量较少,具有较高的安全性。
Objective： To compare the clinical outcome between minimally invasive transforaminal approach and traditional posterior approach in the treatment of single level lumbar tuberculosis, and to evaluate the safety and reliability of minimally invasive trans- foraminal approach for single level lumbar tuberculosis. Methods： 73 patients with single level lumbar tuberculosis were followed up. Among them, 40 cases received traditional posterior surgery, and 43 cases received minimally invasive transforaminal surgery. The operation time, intraoperative blood loss and postoperative drainage were compared between two groups. Clinical outcomes in terms of back pain VAS score and ODI score were performed before surgery and during follow-up. Fusion rate between the two groups was comparied at the time of last follow-up. Results： After surgery, all patients significantly reduced back pain, and body temperature retumed to normal within 2 week. The operation time, intraoperative blood loss and postoperative drainage in minimally invasive transforaminal surgery group were 180± 35, 350± 50, 320± 80 respectively, which were significantly less than 180± 35, 350± 50, 320± 80 respectively in traditional surgery group （P〈0.05）. When followed up before surgery and 1 month, 3 month, 6 month, 12 month, final time after surgery, the low back pain VAS scores were 8.7± 1.2, 4.5± 1.1, 3.5± 1.1, 2.0± 1.4, 1.3± 0.5,1.2± 0.5 and the ODI scores were （77± 6）%, （31± 5）%, （23± 8）%, （14± 6）%, （8± 4）%, （7± 3）% respectively in minimally invasive transforaminal surgery group. At the same times, the VAS scores were 8.5± 1.1, 2.7± 0.7, 2.1± 0.6, 1.9± 0.7, 1.1± 0.4, 1.1± 0.4, and the ODI scores were （78± 5）%, （23± 6）%, （14± 7）%, （12± 5）%, （7± 2）%, （7± 2）% respectively in traditional surgery group. The VAS and ODI scores in minimally invasive transforaminal surgery group were lower than that of traditional posterior surgery group at 1 and 3 months after operation（P〈
出处
《现代生物医学进展》
CAS
2015年第35期6961-6964,6983,共5页
Progress in Modern Biomedicine
基金
2014年总参军事医学和老年病科研基金重点项目(ZCWS14B05)
2014年解放军309医院院内立项面上课题(2014MS-010)
关键词
腰椎结核
微创手术
经椎间孔入路
Lumbar tuberculosis
Minimally invasive surgery
Transforaminal
