单纯后路与前后路联合入路治疗腰骶段脊柱结核的回顾性研究：至少 7 年随访。

Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up.

机构信息

Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.

Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.

出版信息

J Orthop Surg Res. 2020 Mar 10;15(1):99. doi: 10.1186/s13018-020-01616-7.

BACKGROUND

There is no comparative study with long-term follow-up between posterior-only and combined posterior-anterior approaches in treating lumbar spinal tuberculosis (LSTB) and lumbosacral spinal tuberculosis (LSSTB). This retrospective study aimed to compare and evaluate the long-term outcomes of these two surgical approaches in LSTB and LSSTB.

METHODS

Thirty patients with LSTB and 12 patients with LSSTB underwent posterior-only approach (group A); 26 patients with LSTB and 14 patients with LSSTB were managed with combined posterior-anterior approaches (group B). Analysis and comparison in clinical and radiographic outcomes between the two groups were performed.

RESULTS

The intra-operative bleeding amount, surgery time, and hospitalization days in group A were less than that in group B (P < 0.05). These patients were followed for a minimum of 7 years. All patients achieved completely healing within 2-year follow-up. Bony fusion was obtained in all patients. The visual analog scale, Japanese Orthopedic Association score, Oswestry Disability index, and Kirkaldy-Willis functional evaluation at the final visit demonstrated that all patients in both groups achieved satisfactory results. There was no significant difference in angle correction or maintaining correction between combined posterior-anterior approaches and posterior-only approach (P > 0.05). Complications occurred in both groups.

CONCLUSIONS

Both combined posterior-anterior approaches and posterior-only approach can achieve satisfactory clinical and radiological outcomes of long-term in treating LSTB and LSSTB, while posterior-only approach can safely and effectively achieve lesion debridement, decompression, and stability reconstruction and maintenance with the advantages of less invasive surgery, less bleeding, shorter surgery time, and hospital stay, and fewer complications. So, posterior-only approach seemed to be superior to the combined posterior-anterior one.

背景

对于治疗腰椎脊柱结核（LSTB）和腰骶脊柱结核（LSSTB），还没有后路与前后路联合两种方法进行长期随访的对比研究。本回顾性研究旨在比较和评估这两种手术方法治疗 LSTB 和 LSSTB 的长期疗效。

方法

30 例 LSTB 患者和 12 例 LSSTB 患者行后路单纯手术（A 组）；26 例 LSTB 患者和 14 例 LSSTB 患者行前后路联合手术（B 组）。对两组患者的临床和影像学结果进行分析和比较。

结果

A 组术中出血量、手术时间和住院天数均少于 B 组（P<0.05）。所有患者随访至少 7 年。所有患者在 2 年随访内均完全愈合。所有患者均获得骨性融合。末次随访时，视觉模拟评分、日本矫形协会评分、Oswestry 功能障碍指数和 Kirkaldy-Willis 功能评价均显示两组患者均获得满意结果。前后路联合与后路单纯两种方法在角度矫正和维持矫正方面无显著差异（P>0.05）。两组均有并发症发生。