Cui Xu, Ma Yuan-zheng, Li Hong-wei, Chen Xing, Cai Xiao-jun, Bai Yi-bing, Guo Li-xin, Xue Hai-bin
Department of Orthopedics, No. 309 Hospital of PLA, Beijing 100091, China.
Zhonghua Yi Xue Za Zhi. 2012 May 22;92(19):1325-9.
To compare the outcomes of anterior verus posterior instrumentation under different surgical procedures in the surgical management of thoracolumbar spinal tuberculosis (TB).
Between January 2004 and December 2009, 241 adult patients with thoracolumbar spinal TB underwent radical debridement and strut grafting plus anterior or posterior instrumentation in single-stage or two-stages. The mean age was 39 years (range: 16 - 67). The mean follow-up period for 189 patients was 37 months (range: 22 - 72). Among them, 157 cases underwent > 3 weeks of chemotherapeutic regimen of isoniazid, rifampin, pyrazinamide and ethambutol and the remaining 32 were operated for neurological impairment after 6-18 h with the same chemotherapeutic regimen. Except for 8 patients with skip lesions undergoing hybrid anteroposterior instrumentation, anterior instrumentation was utilized in 74 patients (Group A) and posterior instrumentation in 107 patients (Group B).
In both groups, local symptoms of all patients were relieved significantly 1-3 weeks postoperatively. And 10/14 cases (71%) in Group A and 14/19 cases (74%) in Group B with neurological deficits had excellent or good clinical outcomes (P > 0.05). The levels of erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.4 mm/h preoperatively to normal at 8-12 weeks postoperatively. Kyphosis degrees were corrected by a mean of 11.5° in Group A and 12.6° in Group B (P < 0.01). The correction loss was 6.8° in Group A and 6.1° in Group B at the last follow-up (P < 0.01). Fusion rates of the grafting bone were 92.5% and 91.8% respectively at the final follow-up (P > 0.05). Severe complications did not occur.
Either anterior or posterior instrumentation can obtain good results in correction and maintenance of deformity, clearance of foci, decompression of spinal cord and pain relief in the treatment of thoracolumbar spinal TB as long as the surgical indications are properly selected. Posterior instrumentation may be superior to anterior instrumentation in the correction and maintenance of deformity.
比较在胸腰椎脊柱结核手术治疗中，不同手术方式下前路与后路内固定的治疗效果。
2004年1月至2009年12月期间，241例成年胸腰椎脊柱结核患者接受了一期或两期的根治性清创、支撑植骨加前路或后路内固定手术。平均年龄为39岁（范围：16 - 67岁）。189例患者的平均随访期为37个月（范围：22 - 72个月）。其中，157例患者接受了为期>3周的异烟肼、利福平、吡嗪酰胺和乙胺丁醇化疗方案，其余32例在接受相同化疗方案6 - 18小时后因神经功能障碍接受手术。除8例跳跃性病变患者接受前后联合内固定外，74例患者采用前路内固定（A组），107例患者采用后路内固定（B组）。
两组患者术后1 - 3周局部症状均明显缓解。A组14例神经功能缺损患者中有10例（71%）、B组19例中有14例（74%）获得了优良的临床效果（P>0.05）。红细胞沉降率（ESR）水平从术前的43.6mm/h和42.4mm/h在术后8 - 12周恢复正常。A组后凸畸形平均矫正11.5°，B组平均矫正12.6°（P<0.01）。末次随访时A组矫正丢失6.8°，B组矫正丢失6.1°（P<0.01）。最终随访时植骨融合率分别为92.5%和91.8%（P>0.05）。未发生严重并发症。
只要正确选择手术适应证，前路或后路内固定在胸腰椎脊柱结核的治疗中，在矫正和维持畸形、清除病灶、脊髓减压及缓解疼痛方面均可取得良好效果。后路内固定在矫正和维持畸形方面可能优于前路内固定。
