Wang Yuxiang, Xiao Shuntian, Zeng Guohui, Zhang Hongqi, Alonge Emmanuel, Yang Zhuocheng
Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China.
Neurospine. 2024 Sep;21(3):954-965. doi: 10.14245/ns.2448356.178. Epub 2024 Sep 30.
The main objective of this study was to analyze the efficacy and feasibility of surgical management for patients with thoracic spinal tuberculous spondylitis (STB) by using posterior-only transforaminal debridement and interbody fusion (PTDIF) with preservation of posterior ligamentous complex (PLC) and noninferior of PTDIF compared with conventional posterior-only debridement and interbody fusion (CPDIF).
From January 2019 to January 2022, a prospective, randomized, controlled trial was conducted in which patients with thoracic STB were enrolled and assigned to undergo either the PTDIF group (group A) or CPDIF group (group B) in a 1:1 ratio. The clinical efficacy was evaluated on average operation time, blood loss, hospitalization durations, visual analogue scale, Oswestry Disability Index scores, erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), and neurological function recovery using the American Spinal Injury Association's impairment scale and operative complications. Radiological measurements included kyphosis correction, loss of correction. The outcomes were compared between the groups at preoperation, postoperaion, and final follow-up.
All 65 patients were completely cured during the follow-up. The intraoperative blood loss and operation time in group B were more than that in group A. All patients were pain-free at the final follow-up visit. ESR, CRP returned to normal limits in all patients 3 months after surgery. All patients had improved neurological signs. No significant difference was found in kyphosis angle correction, loss of correction between the 2 groups.
PTDIF, with preservation of PLC, achieved debridement, decompression, and reconstruction of the spine's stability, similar to CPDIF in the surgical treatment of thoracic STB. PTDIF has less surgical trauma with less intraoperative blood loss and operation time.
本研究的主要目的是分析单纯后路经椎间孔清创融合术（PTDIF）治疗胸椎结核性脊柱炎（STB）患者的疗效和可行性，该术式保留后韧带复合体（PLC），且与传统单纯后路清创融合术（CPDIF）相比，PTDIF并不逊色。
2019年1月至2022年1月，进行了一项前瞻性、随机、对照试验，纳入胸椎STB患者，并按1:1比例分配至PTDIF组（A组）或CPDIF组（B组）。通过平均手术时间、失血量、住院时间、视觉模拟量表、Oswestry功能障碍指数评分、红细胞沉降率（ESR）、C反应蛋白（CRP）以及使用美国脊髓损伤协会损伤量表评估神经功能恢复情况和手术并发症来评估临床疗效。影像学测量包括后凸畸形矫正、矫正丢失情况。在术前、术后及最终随访时对两组结果进行比较。
所有65例患者在随访期间均完全治愈。B组术中失血量和手术时间均多于A组。所有患者在最终随访时均无疼痛。所有患者术后3个月ESR、CRP恢复至正常范围。所有患者神经体征均有改善。两组在后凸角矫正、矫正丢失方面差异无统计学意义。
保留PLC的PTDIF在胸椎STB的手术治疗中实现了清创、减压及脊柱稳定性重建，与CPDIF相似。PTDIF手术创伤较小，术中失血量和手术时间较少。
