摘要
目的比较斜外侧入路微创通道下病灶清除植骨融合联合经皮椎弓根螺钉内固定术与开放前后路联合病灶清除植骨融合内固定术治疗腰椎结核的临床效果。方法收集西安交通大学第一附属医院自2017年3月至2020年1月收治的47例腰椎结核患者临床资料,其中接受斜外侧入路微创通道下病灶清除植骨融合联合经皮椎弓根螺钉内固定术的患者22例(微创组),接受开放前后路联合病灶清除植骨融合内固定术的患者25例(对照组)。收集两组患者的年龄、性别、体质指数、有无结核全身症状等一般资料,比较患者手术时间、术中出血量、术后引流量、住院时间及并发症等围手术期相关指标,以及患者术前和术后3个月、6个月及末次随访时视觉模拟评分(VAS)、血沉(ESR)、Oswestry功能障碍指数(ODI)评分、腰椎前凸Cobb角及植骨融合情况。结果两组患者手术均顺利完成,术前一般资料差异无统计学意义(P>0.05)。微创组患者手术时间[(188.64±18.59)min vs.(201.60±22.67)min]、术中出血量[(118.64±22.95)mL vs.(553.60±100.54)mL]、术后引流量[(134.55±36.48)mL vs.(291.20±61.53)mL]、住院时间[(12.86±2.17)d vs.(15.80±3.03)d]均少于对照组,差异具有统计学意义(P<0.05),而融合时间及并发症发生率差异无统计学意义(P>0.05)。与术前比较,两组患者术后随访各时间点ESR、VAS评分、ODI评分均降低,腰椎前凸Cobb角增大,差异具有统计学意义(P<0.001);微创组患者仅术后3个月的VAS评分小于对照组[(3.59±0.96)vs.(4.16±0.85)],差异具有统计学意义(P<0.05),而两组间同一时间点其余各指标差异无统计学意义(P>0.05)。结论斜外侧入路微创通道下病灶清除植骨融合联合经皮椎弓根螺钉内固定与开放手术治疗腰椎结核均可取得良好的临床效果,而微创技术可减小手术创伤、缩短住院时间,加速患者术后康复。
Objective To investigate the clinical effects of treatment of single-segment lumbar tuberculosis by oblique lateral interbody fusion with autologous iliac bone and percutaneous pedicle screw fixation. Methods We collected the clinical data of 47 patients with lumbar tuberculosis treated in The First Affiliated Hospital of Xi’an Jiaotong University from March 2017 to January 2020. Among them, 22 patients underwent oblique lateral interbody fusion with autologous iliac bone and percutaneous pedicle screw fixation(minimally invasive group)and 25 patients underwent open surgery combined anterior-debridement and posterior-fixation(control group). The related data were collected, including gender, sex, body mass index(BMI), systemic symptoms of tuberculosis, operation duration, intraoperative bleeding,postoperative drainage, hospital stay, complications, visual analogue score(VAS), erythrocyte sedimentation rate(ESR), and Oswestry disability index(ODI). Results Baseline clinical characteristics did not significantly differ between the two groups(P>0. 05). Compared with control group, the minimally invasive group had shorter operation duration[(188. 64±18. 59)min vs.(201. 60±22. 67)min], less intraoperative blood loss[(118. 64±22. 95)mL vs.(553. 60±100. 54)mL], less postoperative drainage[(134. 55±36. 48)mL vs.(291. 20±61. 53)mL], and shorter hospitalization time [(12. 86±2. 17) d vs.(15. 80±3. 03) d](all P<0. 05). However, there was no significant difference in fusion time or complication rate(P>0. 05). Compared with the preoperative ones, ESR, VAS score and ODI score significantly decreased and Cobb angle significantly increased in both groups(all P<0. 001). At postoperative3 months,the VAS score was lower in the minimally invasive group than in control group[(3. 59±0. 96)vs.(4. 16±0. 85)](P<0. 05). With regard to other characteristics, there was no significant difference between the two groups at the same point(P>0. 05). Conclusion Both minimally invasive technique and open surgery can achieve excellent clinical results,but the minimally invasive technique can reduce the surgical trauma and shorten the hospitalization time.
作者
姜超
尹思
赵为公
张银刚
张小卫
杨益民
张永远
冯超帅
郝定均
杜恒
JIANG Chao;YIN Si;ZHAO Weigong;ZHANG Yingang;ZHANG Xiaowei;YANG Yimin;ZHANG Yongyuan;FENG Chaoshuai;HAO Dingjun;DU Heng(Department of Orthopaedics,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Spine Surgery,Honghui Hospital,Xi’an Jiaotong University,Xi’an 710054,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2022年第1期69-74,共6页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
陕西省重点研发计划项目(No.2020SF-080)
中央高校基本科研业务费专项资金资助项目(No.xjh012019062)。
关键词
腰椎结核
斜外侧椎间融合术
开放手术
病灶清除
经皮椎弓根螺钉内固定
lumbar tuberculosis
oblique lateral interbody fusion
open surgery
debridement
percutaneous pedicle screw internal fixation
作者简介
共同通信作者:尹思,博士,副主任医师.E-mail:yinsi168@163.com;共同通信作者:杜恒,博士,副主任医师,副教授.E-mail:drdu18@126.com。
