| 张 庄,修 鹏,胡博文,汪 雷,刘立岷,曾建成,刘 浩,宋跃明.前路与后路手术治疗上胸椎结核的临床疗效及并发症对比[J].中国脊柱脊髓杂志,2019,(8):684-691. |
| 前路与后路手术治疗上胸椎结核的临床疗效及并发症对比 |
| 中文关键词: 上胸椎结核 病灶清除术 前入路 后入路 |
| 中文摘要: |
| 【摘要】 目的：对比前路与后路手术治疗上胸椎结核（T1～T5）的临床疗效和并发症。方法：回顾性分析我科2005年4月～2014年4月采用手术治疗的29例上胸椎结核患者的临床资料，其中13例行一期前路病灶清除、植骨融合内固定术（前路组），男7例，女6例，年龄22~70岁（46.3±15.0岁）；16例行一期后路病灶清除、植骨融合内固定术（后路组），男7例，女9例，年龄26~72岁（52.6±13.0岁）。术后均给予12~18个月抗结核药物治疗，随访2年以上，比较两组手术时间、出血量、住院时间及围手术期并发症，分析两组在神经功能改善、胸背痛评分、植骨融合时间、后凸畸形矫正及复发率方面的差异。结果：两组均顺利完成手术，前路组和后路组手术时间、术中出血量、住院时间分别为239.1±52.9min和228.0±26.8min、588.5±196.0ml和537.5±208.6ml、23.2±3.1d和16.8±3.1d，其中前路组住院时间显著性大于后路组（P＜0.05）。前路组发生8例次并发症（2例胸腔积液、1例翼状肩、1例气胸、1例肺不张、1例肋间神经痛、1例髂骨供区疼痛、1例双肺细菌性感染伴顽固性低钠血症），后路组发生4例次并发症（2例脑脊液漏、1例切口延迟愈合、1例术后神经症状一过性加重），前路组并发症发生率（3/18，61.54%）大于后路组（4/16，25%）（P＜0.05）。随访40~87个月（62.1±13.0个月），两组患者均获得临床治愈，无结核复发病例。前路组后凸Cobb角术前39.2°±9.4°，术后19.4°±4.7°，末次随访时22.5°±7.4°，矫正丢失3.1°±2.3°；后路组后凸Cobb角术前40.6°±7.3°，术后18.5°±3.5°，末次随访时21.2°±4.4°，矫正丢失2.7°±1.6°，两组间比较差异无统计学意义（P＞0.05）。前路组植骨融合时间（6.2±1.6个月）小于后路组（8.4±1.5个月），差异有统计学意义（P＜0.05）。前路组和后路组末次随访时的神经功能改善率及胸背痛VAS评分分别为100%和93.75%、2.16±0.75和2.01±0.68，两组间比较差异无统计学意义（P＞0.05）。结论：前后手术入路均可用于上胸椎结核的手术治疗，前路手术植骨融合早于后路手术，但前路手术围手术期并发症发生率高于后路手术。 |
Comparison of clinical efficacy and complications between anterior and posterior operations in the treatment of upper thoracic tuberculosis |
| 英文关键词:Upper thoracic tuberculosis Debridement Anterior approach Posterior approach |
| 英文摘要: |
| 【Abstract】 Objectives: To compare the clinical efficacy and complication rate between anterior and posterior approaches in the treatment of upper thoracic tuberculosis(T1-T5). Methods: Retrospective analysis on 29 patients with upper thoracic tuberculosis, who underwent operation in our department from April 2005 to April 2014. Among them, 13 patients(7 males and 6 females, aged 22-70, mean age 46.3±15.0) were treated with one-stage anterior radical debridement and interbody fusion with instrumentation(anterior group); 16 patients(7 males and 9 females, aged 26-72, mean age 52.6±13.0) were treated with one-stage posterior radical debridement and interbody fusion with instrumentation(posterior group). For all 29 patients, anti-tuberculosis drugs were given for 12 to 18 months after operation, and the follow-up periods were more than 2 years. Differences in operation time, blood loss, length of stay(LOS), perioperative complications of the two groups were compared, and neurological improvement, thoracic and back pain VAS score, bone graft fusion time, kyphosis correction and recurrence rate from follow-up data were analyzed. Results: Operations in both groups completed smoothly. The operation time, intraoperative blood loss and LOS of the anterior group and posterior group were 239.1±52.86min and 228.0±26.78min, 588.5±196.0ml and 537.5±208.6ml, 23.15±3.13d and 16.81±3.19d, respectively. The LOS of the anterior group was longer than that of the posterior group(P<0.05). There were 8 cases of complications in the anterior group (2 cases of pleural effusion, 1 of winged scapula, 1 of pneumothorax, 1 of atelectasis, 1 of intercostal neuralgia, 1 of iliac donor region pain, and 1 of pneumonia with refractory hyponatremia), whereas 4 cases of complications occurred in the posterior group(2 cases of cerebrospinal fluid leakage, 1 of delayed wound healing, 1 of transient neurological function worsening). The complication rate of the anterior group(8/13, 61.54%) was greater than that of the posterior group(4/16, 25%)(P<0.05). All 29 patients in both groups were clinically cured without tuberculosis recurrence during the follow-up of 40-87(62.1±13.0) months. The Cobb angle was 39.2°±9.4° before operation, 19.4°±4.7° after operation, and 22.5°±7.4° at the final follow-up, with correction loss of 3.1°±2.3° in the anterior group, and that was 40.6°±7.3°, 18.5°±3.5°, and 21.2°±4.4° respectively in the posterior group, with correction loss of 2.7°±1.6°. There was no significant difference between the two groups(P＞0.05). In terms of the bone graft fusion time, the anterior group(6.2±1.6 months) was shorter than the posterior group(8.4±1.5 months), and the difference was statistically significant(P＜0.05). The neurological improvement rates and thoracic and back pain VAS scores of the anterior group and posterior group at the final follow-up were 100% and 93.75%, 2.16±0.75 and 2.01±0.68, respectively, and the difference was not statistically significant(P＞0.05). Conclusions: Both anterior and posterior approaches can be performed in the surgical treatment of upper thoracic tuberculosis. Comparing with posterior approach, in anterior approach operation the bone graft fusion time was shorter, however, the incidence of perioperative complications was higher. |
| 投稿时间：2019-04-23 修订日期：2019-07-13 |
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