Peng Qiqi, Ou Yunsheng, Zhu Yong, Zhao Zenghui, Luo Wei, Du Xing, Li Jianxiao
Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.
Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Jul 15;32(7):912-919. doi: 10.7507/1002-1892.201801068.
To compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach.
Between June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification ( >0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification.
Except that the operation time of group B was significantly longer than that of group A ( =-2.985, =0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups ( >0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal fluid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups ( <0.05); and there was no significant difference between 2 groups at last follow-up ( >0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up ( =-2.716, =0.007).
Posterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required.
比较经后路与经前路腰大肌脓肿清创并在脓腔内局部化疗联合病灶清创、植骨及后路内固定治疗胸腰椎脊柱结核的疗效，探讨经后路腰大肌脓肿清创的可行性。
回顾性分析2012年6月至2015年12月收治的37例胸腰椎脊柱结核合并腰大肌脓肿患者的临床资料。所有患者均行后路病灶清创、植骨及内固定，并根据腰大肌脓肿清创方式的不同分为两组。A组21例患者经后路行脓肿清创并在脓腔内局部化疗；B组16例患者经前路行脓肿清创并在脓腔内局部化疗。两组患者在性别、年龄、病程、受累节段、术前红细胞沉降率（ESR）、术前C反应蛋白（CRP）、腰大肌脓肿侧别、腰大肌脓肿最大横径及矢状径、合并脓肿、脓腔分隔、术前受累节段Cobb角、术前美国脊髓损伤协会（ASIA）分级等方面比较，差异均无统计学意义（P>0.05）。记录并比较两组患者的手术时间、术中出血量、住院时间、脓肿吸收时间及骨融合时间。观察术前、术后受累节段Cobb角的变化。根据ASIA分级评估神经功能。
除B组手术时间显著长于A组（t=-2.985，P=0.005）外，两组患者术中出血量、住院时间、脓肿吸收时间及骨融合时间比较，差异均无统计学意义（P>0.05）。所有患者均获随访，随访时间18～47个月，平均31.1个月。术中及术后均未发生脑脊液漏。A组4例患者二期经前路行脓肿清创并在脓腔内局部化疗。所有患者脓肿均吸收，末次随访时ESR及CRP水平均恢复正常。两组患者末次随访时受累节段Cobb角较术前均明显改善（P<0.05）；两组间比较，差异无统计学意义（P>0.05）。9例脊髓损伤患者末次随访时神经功能均有明显恢复（t=-2.716，P=0.007）。
后路病灶清创、植骨、内固定联合脓腔脓肿清创及局部化疗治疗胸腰椎脊柱结核疗效确切，但部分病例仍需行前路脓肿清创。
