Liao Yehui, Ye Rupei, Tang Qiang, Tang Chao, Ma Fei, Luo Ning, Zhong Dejun
Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
World Neurosurg. 2020 Feb;134:e956-e967. doi: 10.1016/j.wneu.2019.11.044. Epub 2019 Nov 19.
In this retrospective comparative study, the efficacy and clinical outcomes of long posterior instrumentation, with or without laminectomy, were evaluated and the necessity of the second stage of anterior debridement in the treatment of spinal tuberculosis (TB) was discussed.
This retrospective study included 41 patients who were diagnosed with spinal TB between January 2010 and June 2016. A total of 18 patients had received long posterior instrumentation, with or without laminectomy (group A), whereas the other 23 patients had posterior instrumentation plus anterior debridement and autogenous bone grafting (group B). The surgical information, clinical effectiveness, laboratory tests, and imaging results were compared between the 2 groups.
One patient in group B died. Sinus drainage and incomplete bone fusion were discovered 1 year postoperatively. TB symptoms were significantly improved after surgery compared with those before surgery (P < 0.05), and there was no significant difference in the treatment efficacy between the 2 groups at the final follow-ups (P > 0.05). Compared with those of group B, the surgical time, bed-rest time, and hospitalization time of group A were all significantly shorter (P < 0.05), whereas the times before abscesses disappeared, bone graft fusion, and erythrocyte sedimentation rate returning to normal were all significantly longer (P < 0.05).
Single-stage long posterior instrumentation, with or without laminectomy, is a safe, effective, and feasible method for the treatment of spinal TB. The second stage of anterior debridement surgery may not be necessary for every spinal TB treatment.
在这项回顾性对照研究中，评估了行或不行椎板切除术的长节段后路内固定术的疗效和临床结果，并探讨了脊柱结核（TB）治疗中二期前路清创术的必要性。
这项回顾性研究纳入了2010年1月至2016年6月期间被诊断为脊柱结核的41例患者。共有18例患者接受了行或不行椎板切除术的长节段后路内固定术（A组），而其他23例患者接受了后路内固定术加前路清创术及自体骨移植（B组）。比较了两组之间的手术信息、临床疗效、实验室检查和影像学结果。
B组有1例患者死亡。术后1年发现有窦道引流及骨融合不全。与术前相比，术后结核症状明显改善（P<0.05），末次随访时两组治疗效果差异无统计学意义（P>0.05）。与B组相比，A组的手术时间、卧床时间和住院时间均明显缩短（P<0.05），而脓肿消失、植骨融合及血沉恢复正常的时间均明显延长（P<0.05）。
单阶段长节段后路内固定术，无论是否行椎板切除术，都是治疗脊柱结核的一种安全、有效且可行的方法。并非每例脊柱结核治疗都需要二期前路清创手术。
