前路与后路病灶切除植骨内固定对脊柱结核患者的临床疗效比较

目的:比较前路与后路病灶切除植骨内固定治疗脊柱结核的临床效果。方法:选取我院2014年2月到2015年8月收治的脊柱结核患者82例并采用随机数字法将其分为对照组和观察组,每组各41例。两组患者术前均接受常规抗结核治疗,同时行病灶清除植骨内固定术治疗,其中对照组患者行前路内固定术,观察组患者行后路内固定术。比较两组患者的手术时间、术中出血量、腰背疼痛缓解时间、下床行走时间及住院时间。术后随访6个月,比较两组患者手术前后的Frankel分级和Th17细胞相关因子水平。结果:观察组的腰背疼痛缓解时间、下床行走时间及住院时间均明显低于对照组(P0.01);手术后,观察组的Frankel分级为A级和B级的比例均明显高于对照组(P0.05),血清白细胞介素-10(IL-10)、白细胞介素-17(IL-17)、白细胞介素-23(IL-23)及转化生长因子-β1(TGF-β1)水平均明显低于对照组(P0.01)。结论:前路病灶切除联合后路植骨内固定术能有效促进脊柱结核患者术后的康复,降低脊柱损伤程度,并能减轻机体炎症反应,促进免疫功能恢复。

Comparison of Clinical Effect of Anterior and Posterior Focus Resection and Bone Graft on Spinal Tuberculosis

ABSTRACT Objective: To compare the clinical effect of anterior and posterior resection, bone grafting and internal fixation on the spinal tuberculosis. Methods: 82 cases of patients with spinal tuberculosis in our hospital from February 2014 to August 2015 were selected and randomly divided into the control group and the observation group with 41 cases in each group. Both groups received conventional anti tuberculosis treatment and underwent debridement bone graft and internal fixation treatment, the control group underwent anterior internal fixation, while the observation group underwent posterior internal fixation. The operation time, intraoperative blood loss, low back pain relief time, ambulation time and hospitalization time were compared between two groups. All patients were followed up for 6 months, the Frankel grade and serum Th17 cell related factors levels were compared between two groups before and after operation. Results: The low back pain relief time, ambulation time and hospitalization time of observation group were significantly shorter than those of the control group(P<0.01). After operation, the Frankel classification grade A and B ratio of observation group were significantly higher than those of the control group(P<0.05), the serum IL-10, IL-17, IL-23 and TGF- beta 1 levels were significantly lower than those of the control group(P<0.01). Conclusion: Anterior resection combined with posterior bone graft inFixation could effectively promote the rehabilitation of spinal tuberculosis, reduce the severity of spinal injury, relieve the inflammatory response and promote the recovery of immune function.