Zhang Hongqi, Guo Qiang, Guo Chaofeng, Wu Jianhuang, Liu Jinyang, Gao Qile, Wang Yuxiang
Department of Spine Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.
Medicine (Baltimore). 2017 Nov;96(45):e8574. doi: 10.1097/MD.0000000000008574.
Surgical intervention is an important option for treating lumbar tuberculosis. Previous studies have reported different surgical intervention procedures. To our knowledge, few studies have compared the clinical results of mid-term follow-up of 3 different surgeries in surgical treatment of spinal tuberculosis. This study's purpose is to evaluate the effectiveness of 3 different surgeries for the treatment of lumbar tuberculosis in adult and analyze the mid-term influence of the surgery on quality of life.Between June 2004 and January 2010, a total of 137 adult patients (54 women and 83 men) with lumbar tuberculosis were recruited for this study. The patients were divided into 3 groups based on administered surgeries: posterior, anterior, and combined posterior-anterior. The trauma index (operation time, blood loss, length of hospital stay, and complications), imaging parameters (segment kyphotic angle, correction rate, loss angle, and bone fusion time), and quality-of-life indicators, including Oswestry Disability Index (ODI), the Frankel grade, visual analog scale (VAS), and Macnab score, were collected.The posterior group experienced the lowest trauma index, whereas the combined group faced the highest trauma index. The anterior group's kyphosis correction rate of (52% ± 5.45%) was significantly inferior to the posterior group (74% ± 5.04%) and the combined group (69% ± 7.95%), whereas the loss of correction in the anterior group (2.5°) was higher than the losses of correction in the posterior group (0.8°) and combined group (1.1°). The mean bone fusion times of the 3 groups were similar. Postsurgery quality of life was markedly improved in all patients. The improvement rates of the ODI, VAS, and the excellent and good rate per the Macnab score were similar among the 3 groups at the final follow-up.Based on a retrospective study, for patients with lumbar tuberculosis, use of the anterior approach should be limited. Although the combined approach produced satisfactory outcomes, it remains more traumatic. Compared with the anterior surgery and the combined surgery, the posterior-only approach is safer and less invasive.
手术干预是治疗腰椎结核的重要选择。以往研究报道了不同的手术干预方法。据我们所知，很少有研究比较3种不同手术治疗脊柱结核的中期随访临床结果。本研究旨在评估3种不同手术治疗成人腰椎结核的有效性，并分析手术对生活质量的中期影响。
2004年6月至2010年1月，本研究共纳入137例成年腰椎结核患者（54例女性，83例男性）。根据所施行的手术，将患者分为3组：后路组、前路组和前后联合组。收集创伤指数（手术时间、失血量、住院时间和并发症）、影像学参数（节段后凸角、矫正率、丢失角度和骨融合时间）以及生活质量指标，包括Oswestry功能障碍指数（ODI）、Frankel分级、视觉模拟评分（VAS）和Macnab评分。
后路组创伤指数最低，而联合组创伤指数最高。前路组的后凸矫正率（52%±5.45%）明显低于后路组（74%±5.04%）和联合组（69%±7.95%），而前路组的矫正丢失（2.5°）高于后路组（0.8°）和联合组（1.1°）。3组的平均骨融合时间相似。所有患者术后生活质量均有显著改善。末次随访时，3组的ODI、VAS改善率以及Macnab评分优良率相似。
基于一项回顾性研究，对于腰椎结核患者，应限制前路手术的应用。虽然联合手术取得了满意的效果，但创伤仍然较大。与前路手术和联合手术相比，单纯后路手术更安全，创伤更小。
