Liu Peng, Sun Mingwei, Li Shijun, Wang Zhihui, Ding Guoqiang
Department of Orthopedic Surgery, East Branch, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, 585 North Da Mian Hong He Ave, Long Quan District, Chengdu 610110, People's Republic of China.
Department of Orthopedic Surgery, East Branch, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, 585 North Da Mian Hong He Ave, Long Quan District, Chengdu 610110, People's Republic of China.
Clin Neurol Neurosurg. 2015 Jan;128:25-34. doi: 10.1016/j.clineuro.2014.10.019. Epub 2014 Nov 4.
The purpose of this study was to determine the optimal operative approach for the treatment of spinal tuberculosis. We analyzed two types of pathological vertebrae (thoracic and lumbar) and three cardinal operative approaches for surgery.
Sixty patients with spinal tuberculosis were divided into thoracic (n=30) and lumbar groups (n=30) based on locations of the foci. These patients underwent anti-tuberculosis drug and surgical therapy. The operative approaches for the surgical treatments were the anterior approach (AA, n=20), posterior approach (PA, n=20), and combined anterior and posterior approach (CAPA, n=20). All clinical data from the patients was collected and included surgical time, blood loss, correction of kyphosis, and vertebral body height reconstruction. Differences in the means between the groups were evaluated statistically with one-way analyses of variance (ANOVAs).
The surgery time in the CAPA group was longer than that of AA group (P<0.05), and there were no significant differences between the CAPA and PA groups or the AA and PA groups. The average vertebral body height reconstruction in the AA group was larger than that of the PA or CAPA groups, and there was no significant difference between the PA and CAPA groups (P>0.05). There were no interactions between the location of the pathological vertebra and the type of surgical approach, with the exception of blood loss. The blood loss of the CAPA was greater than those of the AA and PA patients in the thoracic group (P<0.05), and no significant difference was found in the lumbar group (P>0.05).
AA was well-suited for serious vertebral collapse that required reconstruction of the height of the vertebrae. CAPA was unfit for patients with poor basic conditions due to the long surgical time, but the long surgery time of CAPA did not necessarily lead to greater blood loss compared to the other approaches.
本研究旨在确定治疗脊柱结核的最佳手术方法。我们分析了两种类型的病理性椎体（胸椎和腰椎）以及三种主要的手术入路。
60例脊柱结核患者根据病灶位置分为胸椎组（n = 30）和腰椎组（n = 30）。这些患者接受了抗结核药物和手术治疗。手术治疗的手术入路为前路（AA，n = 20）、后路（PA，n = 20）和前后联合入路（CAPA，n = 20）。收集了患者的所有临床数据，包括手术时间、失血量、后凸畸形矫正和椎体高度重建。组间均值差异采用单因素方差分析（ANOVA）进行统计学评估。
CAPA组的手术时间长于AA组（P<0.05），CAPA组与PA组或AA组与PA组之间无显著差异。AA组的平均椎体高度重建大于PA组或CAPA组，PA组和CAPA组之间无显著差异（P>0.05）。除失血量外，病理性椎体位置与手术入路类型之间无相互作用。胸椎组中，CAPA组的失血量大于AA组和PA组患者（P<0.05），腰椎组未发现显著差异（P>0.05）。
前路手术适用于需要重建椎体高度的严重椎体塌陷。前后联合入路由于手术时间长，不适合基础条件差的患者，但与其他入路相比，前后联合入路较长的手术时间不一定导致更多的失血量。
