Surgical Treatment of Thoracic Spinal Tuberculosis: A Multicenter Retrospective Study
Surgical Treatment of Thoracic Spinal Tuberculosis: A Multicenter Retrospective Study
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DOI：
10.1016/j.wneu.2017.11.126
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发表时间：
2018-02-01
影响因子：
2
通讯作者：
Zhang, Zehua
中科院分区：
文献类型：
--
作者：
Wu, Wenjie;Lyu, Jingtong;Zhang, Zehua
目的：对2000年1月至2015年1月收治的394例胸结核病患者进行多中心、回顾性研究，评价不同术式治疗胸结核病的安全性和有效性，为胸结核病的外科治疗提供参考。男208例，女186例，年龄5~76岁，平均34.92±13.14岁。其中一期前路手术73例(A组)，前路联合后路手术84例(B组)，一期后路手术237例(C组)。分析临床结果、实验室指标和放射学结果，观察后路手术的优势。结果：所有病例均获得26~60个月(平均37个月)的随访。在最后一次随访中，所有患者都达到了骨融合、疼痛缓解和神经功能恢复。治疗前后视觉模拟评分和OSwestry功能障碍指数评分差异有统计学意义(P<；0.05)。后路手术明显改善脊柱后凸畸形(P<；0.05)。结论：后路内固定术在矫正脊柱后凸、维持脊柱稳定性方面优于前路内固定术。一期后路手术可达到与单纯前路手术或联合手术相同的疗效，且创伤小、出血少、手术时间短。但对于病变较宽或椎旁脓肿、骨质破坏严重、清创后前中柱缺损较大而不需长节段植骨的患者，应采用前路联合后路手术。
OBJECTIVE: The aim of the present multicenter, retrospective study was to assess the safety and effectiveness of different surgery strategies for the treatment of thoracic tuberculosis and to provide a reference for surgical treatment of thoracic tuberculosis.MATERIALS AND METHODS: This study reviewed 394 patients with thoracic tuberculosis who were treated in 6 institutions between January 2000 and January 2015. There were 208 men and 186 women with an average age of 34.92 +/- 13.14 years (range 5-76 years). A total of 73 patients underwent one-stage anterior surgery (group A); 84 underwent an anterior combined posterior surgery (group B); and 237 underwent one-stage posterior surgery (group C). Clinical outcome, laboratory indexes, and radiologic results were analyzed to observe the advantage of posterior approach surgery.RESULTS: All cases were followed up for about 26-60 months (average of 37 months). At the last follow-up, all patients reached bone fusion, pain relief, and neurologic recovery. There were significant differences before and after treatment in terms of the visual analog scale and Oswestry Disability Index scores (P < 0.05). Posterior approach significantly improved kyphosis (P < 0.05).CONCLUSIONS: Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability. One-stage posterior surgery can achieve the same efficacy as anterior-only or combined surgery, with less trauma, less blood loss, and shorter operative times. However, for wide lesions or paraspinal abscesses, severe bone destruction, and anterior and middle column defects that are too large after debridement to require long segment bone grafting, the anterior combined posterior approach is indispensable.