单纯后路术式与前后路联合术式在脊柱结核治疗中的临床应用及相关研究
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摘要
研究背景：
骨与关节结核曾经是非常多见的感染性疾病,其好发部位为脊柱,约占50%,脊柱结核中椎体结核占多数,附件结核比较少见。颈椎结核占5%左右,胸椎结核占25%左右,腰椎及骶椎结核约占20%左右。由于抗痨药物的广泛使用与生活条件的好转,使骨与关节结核的发病率明显下降。但近年来,由于耐药性结核杆菌的增加,使骨与关节结核的发病率明显增加,全世界每年新增结核病患者800-1000万,结核病患者每年的死亡人数在300万左右。我国是全球22个结核病高发国家之一,位居世界第二。结核病发病率上升的趋势已经引起了全世界医务工作者的重视。为了减轻脊柱结核患者的痛苦、提高脊柱结核患者的生活质量、缩短脊柱结核患者的用药时间以及减少抗痨药物所引起的并发症,国内外学者在脊柱结核治疗的外科术式上以及内固定器械上进行了改进、优化,以至于目前出现了各种外科手术方式并存的现象,可谓是百花齐放百家争鸣,但各种手术方式均各有所长。因此,在这样的背景下,为了能够减少手术的并发症、提高手术效果,为了获得一种相对完美的术式,我们进行了手术方式的对比、研究及改进、优化。
研究目的：
在脊柱结核外科治疗过程中,通过对脊柱结核单纯后路术式组患者与前后路联合术式组患者的对比研究来探讨脊柱结核单纯后路术式的临床应用及效果。
方法：
我科从2004年1月至2010年1月共收治脊柱结核患者650例,其中采用单纯后路术式(即单纯后路经小关节突病灶清除椎体间植骨融合钉棒内固定术)和前后路联合术式(即先行后路钉棒内固定然后一期或二期经胸或胸膜外行前路病灶清除植骨融合)并获得随访的患者共为308例。还有约100例患者也是采用上述两种术式治疗并且符合本文研究对象,由于随访资料不全或术后时间不足2年,暂不作为研究资料。为了便于研究我们根据术式的不同分为两组：(1)前后路联合术式组(156)例,(2)单纯后路术式组(152)例,比较两种术式的住院时间、住院费用、手术时间、术中出血量、手术费用、后凸畸形矫正率、并发症发生率、JOA评分、植骨融合情况,采用3/6/9随访方式,即术后3个月、6个月、9个月随访,以后每年复查一次。
结果：
随访24个月到48个月,平均35.14±9.79个月。两种术式植骨均获得融合,两种术式各有1例窦道形成。Cobb角丢失度无统计学差别,临床疗效两组患者无统计学差别,在后凸畸形矫正率、住院时间、住院费用、手术时间、术中出血量等方面,单纯后路术式明显优于前后路联合术式。
结论：
对于病灶破坏局限于单节段的脊柱结核或每处病灶局限于单节段的跳跃式脊柱结核,单纯后路术式在后凸畸形矫正、住院费用、住院时间、手术时间以及术中出血量等方面明显优于前后路联合术式。
Research background:
Bone and joint tuberculosis was once a very common infectious disease, half of which involved the spine.Most of the spinal tuberculosis is vertebra body tuberculosis,few of which is vertebral accessories.5% of spinal tuberculosis is cervical tuberculosis,25% is thoracic tuberculosis,20% is lumbar and sacral tuberculosis.With the widespread use of antituberculotic gluey drugs and with the improve verb of living conditions, the incidence rate of bone and joint tuberculosis dropped.In recent years, the bone and joint tuberculosis incidence rate showed an increasing trend.There ere an annual increase of 800-1000 worldwild.The tuberculosis deaths is three million every year. China is one of the world's 22 tuberculosis high-burden countries, it is the second in the world. The medical workers of all over the world have payed attention to it. In order to alleviate the pain, improve the living conditions, short the course of chemotherapy, reduce the rate of the drug complications of the patients with spinal TB, the medical workers of all over the world have worked hard to improve the surgical technique and medical apparatus and instruments.Now there are all kinds of surgical techniques. With this background, let's now explore a better surgical technique for the single-segment spinal tuberculosis.
Objective:
To evaluate its indication and clinically applied value by a comparative study of posterior surgery and anterior-posterior surgery in the treatment of spinal tuberculosis.
Methods:
Six hundred and fifty spinal tuberculosis cases were treated surgically at the Xiangya hospital, the department of spinal surgery, between January 2004 and January 2010. And three hundred and eight cases were treated by posterior surgery or anterior-posterior surgery.we divide 308 cases into two groups based on surgery. The two group cases were followed up postoperatively. The hospital stays, hospitalisation, the operation's time and blood loss, Cobb angel, incidence of relapse,incidence of complication, JOA grade, fusion status of the two groups were documented.
Results:
The patients were evaluated and followed for at least 24 months (range, 6 to 48 months). The average follow up was 35.14±9.79 months. All patients achieved solid interbody bone union. Each group had only 1 sinus. The Cobb angle did not change. There was not statistical significance in JOA grade of the two groups. The posterior surgery was better than anterior-posterior surgery in the hospital stays, hospitalisation, the operation's time and blood loss and corrective rate of kyphosis.
Conclusion:
The posterior surgery is better than anterior-posterior surgery in the hospital stays,hospitalisation, the operation's time and blood loss and corrective rate of kyphosis,which is indicative to single-segment spinal tuberculosis or skip spinal tuberculosis.
骨与关节结核曾经是非常多见的感染性疾病,其好发部位为脊柱,约占50%,脊柱结核中椎体结核占多数,附件结核比较少见。颈椎结核占5%左右,胸椎结核占25%左右,腰椎及骶椎结核约占20%左右。由于抗痨药物的广泛使用与生活条件的好转,使骨与关节结核的发病率明显下降。但近年来,由于耐药性结核杆菌的增加,使骨与关节结核的发病率明显增加,全世界每年新增结核病患者800-1000万,结核病患者每年的死亡人数在300万左右。我国是全球22个结核病高发国家之一,位居世界第二。结核病发病率上升的趋势已经引起了全世界医务工作者的重视。为了减轻脊柱结核患者的痛苦、提高脊柱结核患者的生活质量、缩短脊柱结核患者的用药时间以及减少抗痨药物所引起的并发症,国内外学者在脊柱结核治疗的外科术式上以及内固定器械上进行了改进、优化,以至于目前出现了各种外科手术方式并存的现象,可谓是百花齐放百家争鸣,但各种手术方式均各有所长。因此,在这样的背景下,为了能够减少手术的并发症、提高手术效果,为了获得一种相对完美的术式,我们进行了手术方式的对比、研究及改进、优化。
研究目的：
在脊柱结核外科治疗过程中,通过对脊柱结核单纯后路术式组患者与前后路联合术式组患者的对比研究来探讨脊柱结核单纯后路术式的临床应用及效果。
方法：
我科从2004年1月至2010年1月共收治脊柱结核患者650例,其中采用单纯后路术式(即单纯后路经小关节突病灶清除椎体间植骨融合钉棒内固定术)和前后路联合术式(即先行后路钉棒内固定然后一期或二期经胸或胸膜外行前路病灶清除植骨融合)并获得随访的患者共为308例。还有约100例患者也是采用上述两种术式治疗并且符合本文研究对象,由于随访资料不全或术后时间不足2年,暂不作为研究资料。为了便于研究我们根据术式的不同分为两组：(1)前后路联合术式组(156)例,(2)单纯后路术式组(152)例,比较两种术式的住院时间、住院费用、手术时间、术中出血量、手术费用、后凸畸形矫正率、并发症发生率、JOA评分、植骨融合情况,采用3/6/9随访方式,即术后3个月、6个月、9个月随访,以后每年复查一次。
结果：
随访24个月到48个月,平均35.14±9.79个月。两种术式植骨均获得融合,两种术式各有1例窦道形成。Cobb角丢失度无统计学差别,临床疗效两组患者无统计学差别,在后凸畸形矫正率、住院时间、住院费用、手术时间、术中出血量等方面,单纯后路术式明显优于前后路联合术式。
结论：
对于病灶破坏局限于单节段的脊柱结核或每处病灶局限于单节段的跳跃式脊柱结核,单纯后路术式在后凸畸形矫正、住院费用、住院时间、手术时间以及术中出血量等方面明显优于前后路联合术式。
Research background:
Bone and joint tuberculosis was once a very common infectious disease, half of which involved the spine.Most of the spinal tuberculosis is vertebra body tuberculosis,few of which is vertebral accessories.5% of spinal tuberculosis is cervical tuberculosis,25% is thoracic tuberculosis,20% is lumbar and sacral tuberculosis.With the widespread use of antituberculotic gluey drugs and with the improve verb of living conditions, the incidence rate of bone and joint tuberculosis dropped.In recent years, the bone and joint tuberculosis incidence rate showed an increasing trend.There ere an annual increase of 800-1000 worldwild.The tuberculosis deaths is three million every year. China is one of the world's 22 tuberculosis high-burden countries, it is the second in the world. The medical workers of all over the world have payed attention to it. In order to alleviate the pain, improve the living conditions, short the course of chemotherapy, reduce the rate of the drug complications of the patients with spinal TB, the medical workers of all over the world have worked hard to improve the surgical technique and medical apparatus and instruments.Now there are all kinds of surgical techniques. With this background, let's now explore a better surgical technique for the single-segment spinal tuberculosis.
Objective:
To evaluate its indication and clinically applied value by a comparative study of posterior surgery and anterior-posterior surgery in the treatment of spinal tuberculosis.
Methods:
Six hundred and fifty spinal tuberculosis cases were treated surgically at the Xiangya hospital, the department of spinal surgery, between January 2004 and January 2010. And three hundred and eight cases were treated by posterior surgery or anterior-posterior surgery.we divide 308 cases into two groups based on surgery. The two group cases were followed up postoperatively. The hospital stays, hospitalisation, the operation's time and blood loss, Cobb angel, incidence of relapse,incidence of complication, JOA grade, fusion status of the two groups were documented.
Results:
The patients were evaluated and followed for at least 24 months (range, 6 to 48 months). The average follow up was 35.14±9.79 months. All patients achieved solid interbody bone union. Each group had only 1 sinus. The Cobb angle did not change. There was not statistical significance in JOA grade of the two groups. The posterior surgery was better than anterior-posterior surgery in the hospital stays, hospitalisation, the operation's time and blood loss and corrective rate of kyphosis.
Conclusion:
The posterior surgery is better than anterior-posterior surgery in the hospital stays,hospitalisation, the operation's time and blood loss and corrective rate of kyphosis,which is indicative to single-segment spinal tuberculosis or skip spinal tuberculosis.
引文
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