摘要
目的 比较前后联合入路一期后路固定、二期前路病灶切除、钛笼植骨融合与一期病灶切除、钛笼植骨融合并椎弓根螺钉治疗老年胸腰椎结核的临床效果及安全性.方法 选取2017年1月～2020年12月在潍坊市第二人民医院收治的老年胸腰结核患者30例.A组行一期病灶切除、钛笼植骨融合并椎弓根螺钉内固定(15例);B组行一期后路固定、二期前路病灶切除、钛笼自体骨植骨融合手术(15例).抗结核治疗贯穿整个治疗过程.分别对两组患者的手术情况、住院恢复情况、并发症发生情况以及生活质量进行比较.结果 ①B组患者的手术所使用的时间、术中的出血量以及术后引流量均显著少于A组,差异有统计学意义(P＜0.05);②术后B组患者的CRP、ESR明显低于A组,差异有统计学意义(P＜0.05);③术后1周两组患者的Cobb角比较,差异无统计学意义(P＞0.05);④术后两组患者的QOL评分、KPS评分比较,差异均无统计学意义(P＞0.05);两组患者随访期间均未见结核复发以及椎弓根螺钉断裂等严重并发症,CT复查均显示骨性融合.结论 不同手术方式治疗老年胸腰椎结核均取得较好的临床效果,前后联合入路一期后路固定、二期前路病灶切除、钛笼植骨融合治疗老年胸腰椎结核,在减少手术时间、术中出血量具有显著优势,在老年患者中可进行选择.
Abstract
Objective To compare the clinical efficacy and safety of one-stage posterior fixation,two-stage anterior lesion resection,titanium cage bone graft fusion with one-stage lesion resection,titanium cage bone graft fusion with pedicle screws in the treatment of the elderly.Methods Thirty elderly patients with thoracolumbar tuberculosis ad-mitted to the Second People's Hospital of Wei fang City from January 2017 to December 2020 were selected.They were divided into two surgical groups:Group A underwent primary lesion resection,titanium cage bone grafting fusion,and pedicle screw internal fixation(15 cases);Group B underwent one-stage posterior fixation,two-stage anterior lesion resec-tion,and titanium cage autogenous bone graft fusion surgery(15 cases).Anti tuberculosis treatment runs through the en-tire treatment process.Compare the surgical conditions,hospital recovery,incidence of complications,and quality of life between two groups of patients.Results ①The surgical time were less than those of Group A(P＜0.05);(2)The CRP and ESR of postoperative group B patients were lower than those of group A(P＜0.05);(3)There was no statistically difference in Cobb angle between the two groups of patients(P＞0.05);(4)There was no difference in the QOL score and KPS score between the two groups of patients after surgery(P＞0.05);During the follow-up period,no serious complica-tions such as tuberculosis recurrence or pedicle screw breakage were observed in both groups of patients.CT scans showed bone fusion.Conclusion Different surgical methods have achieved good clinical results in the treatment of the elderly.The combination of anterior and posterior approach,one-stage posterior fixation,two-stage anterior lesion resec-tion,and titanium cage bone grafting fusion have significant advantages in reducing surgical time and intraoperative bleeding,Choices can be made among elderly patients.
基金项目
潍坊市卫生健康委科研项目(WFWSJK-2020-281)
NETL
NSTL
万方数据