摘要
目的比较一期侧前路病灶清除植骨融合双钉棒固定术与一期后路病灶清除植骨椎弓根螺钉固定术治疗腰骶段结核的术式优缺点及临床疗效。方法回顾性分析2004-01~2015-06西安交通大学第二附属医院56例腰骶段结核的治疗,其中一期侧前路病灶清除植骨融合双钉棒固定组(A组)29例,一期后路病灶清除植骨融合椎弓根螺钉固定组(B组)27例。记录两组患者手术时间,出血量,住院时间,术前、术后及末次随访VAS疼痛评分(visual analogue scale,VAS),血沉,腰骶段前凸角度,脊髓功能ASIA分级,植骨融合时间,比较同组间术前术后以及不同时间点两组间差异;记录并发症。结果两组手术时间、出血量、住院时间及植骨融合时间比较差异无统计学意义(P>0.05);两组术后1周及末次随访血沉、VAS评分均较术前降低,差异有统计学意义(P<0.05);前凸角度较术前增加,差异有统计学意义(P<0.05);美国脊柱损伤协会(American Spinal Injury Associaion,ASIA)神经功能分级末次随访与术前分级比较,差异有统计学意义(P<0.01)。两组间上述指标比较差异无统计学意义。两组患者均无严重并发症出现。结论一期侧前路病灶清除植骨融合双钉棒固定术与一期后路病灶清除植骨椎弓根螺钉固定术治疗腰骶段结核均能达到满意疗效;但两种手术方案各有利弊,具体病例的手术方案选择需根据病情及术者经验决定。
Objective To compare advantages and disadvantages,clinical efficacy of one-stage anterior debridement,bone fusion com- bined with dual screw-rod construct fixation versus one-stage posterior debridement and bone fusion with pedicle screws in treatment of lumbosacral spinal tuberculosis. Methods Clinical data of 56 patients suffering from lumbesacral tuberculosis from January 2004 to June 2015 were reviewed retrospectively. Among 56 patients,29 patients were treated with one-stage anterior debridement, bone fusion combined with dual screw-rod construct fixation（ group A）, and 27 patients were treated with one-stage posterior debridement, bone fu- sion with pedicle screws （ group B）. The operation time, bleeding volume, hospitalization time, preoperative, postoperative and last follow- up VAS scores, erythrocyte sedimentation rate（ESR） ,lumbosacral lordosis angle, ASIA grade,bone graft fusion time were recorded and compared between the two groups. The complications were recorded. Results There was no signi/icant difference between the two groups in operation time, bleeding volume, hospitalization time and bone graft fusion time （ P 〉 0. 05 ）. The ESR, VAS scores were de- creased and the lordosis angle was increased in the two groups at one week and the last follow-up after operation （ P 〈 0. 05 ）. The ASIA grades at the last follow-up were significantly improved in the two groups after operation（P 〈0. 01 ） ,and all patients achieved grade E. There was no significant difference in ESR, VAS scores and the lordosis angle between the two groups. There were no serious complica- tions in both groups. Conclusion The one-stage anterior debridement, bone fusion combined with dual screw-rod construct fixation and one-stage posterior debridement, bone fusion with pedicle screws can achieve satisfactory clinical outcome,but the two surgical pro- grams have their own advantages and disadvantages, so the surgery decision should be based on the disease and the experience of the surgeons for specific
作者
臧全金
贺西京
李浩鹏
杨平林
张廷
ZANG Quanjin HE Xijing LI Haopeng YANG Pinglin ZHANG Ting(Second Department of Orthopaedics, Second Affiliated Hospital, Xi＇ an Jiaotong University, Xi＇ an 710004, China)
出处
《山西医科大学学报》
CAS
2017年第6期605-611,共7页
Journal of Shanxi Medical University
基金
国家自然科学基金资助项目(81571209)
陕西省自然科学基金资助项目(2016JM8054)
关键词
腰骶部
脊柱结核
手术入路
对比研究
lumbosacral segment
spinal tuberculosis
surgical approach
comparative study
