| Objective: To evaluate the safety and effectiveness of the two surgical approaches for the treatment of lumbar spinal tuberculosis by comparing and analyzing the lateral anterior Extraperitoneal approach and posterior approach for the debridement and intervertebral bone grafting for lumbar tuberculosis.And provide a reference to surgical options for single-segment tuberculosis.Methods: The clinical data of 42 patients with single-segment lumbar tuberculosis undergoing surgical treatment in the First Affiliated Hospital of Guangxi Medical University from March 2015 to May 2019 were collected and divided into two groups according to different surgical approaches,group A is lateral anterior retroperitoneum approach,and group B is posterior approach.The number of cases in group A was 23 and group B was 19 cases.The statistical methods were used to compare and analyze the changes of indexes between the two groups,such as bleeding volum,operation time,postoperation drainage,length of hospital stay,nerve function,ESR and Cobb angle.Results: 42 patients were followed up: the follow-up time of group A was10 to 47 months,with an average of 28.7months;the follow-up time of group B was 9 to 50 months,with an average of 17.4 months.The average bleeding volum during operation in group A was 365.22 ± 274.46 ml,the operation time was 117.60 ± 39.33 min and the length of stay was 8.83 ± 1.90 days,and the bone fusion time was 6.53± 0.67 months,and the bed rest days after operation were 3.43 ± 1.20.In group B,The average bleeding volum were378.95±260.51 ml,the operation time was 134.41±52.78 min,the length of stay was 10.11±3.49 days,the bed rest days after operation were 5.11 ± 1.29.In the intragroup comparison,the VAS score,kyphosis Cobb angle,and Erythrocyte Sedimentation Rate of the two groups at the last follow-up were significantly better than those before the operation.The specific numerical comparison were as follows: VAS(Group A :1.00 ± 1.04vs6.43 ± 0.79,P = 0.00;Group B 1.53 ±0.90vs6.68 ± 0.95,P = 0.00);ESR(Group A: 20.96 ± 10.88vs50.91 ± 30.77,P= 0.00;Group B: 30.95 ± 25.43vs47.26 ± 24.01,P = 0.03),Group A preoperative Cobb angle(25.82 ± 8.57)°,postoperative(16.49 ± 6.85)°,last follow-up(22.04 ± 7.34)°;group B preoperative Cobb angle(25.77 ± 7.78)°,postoperative(12.89 ± 4.38)°,the last follow-up(16.47 ± 5.04)°,group B had better orthopedic effect than group A.In the comparison between 2 groups,the postoperative drainage volume of group A was significantly less than group B,and the number of lying in bed after operation,A was more than group B.There was no statistical difference in operation time,hospital stay,intraoperative blood loss,and ESR(P >0.05),Analysis of VAS,Erythrocyte Sedimentation Rate,and diseased vertebral Cobb angle before and after operation showed statistically significant differences(P ﹤ 0.05).All patients reached the clinical cure standard,and the symptoms of low back pain were significantly alleviated compared with preoperation.In group A,there were 2 cases of discomfort in the iliac bone extraction area and 1 case infection after operation;in group B,2cases of nerve root injury occurred after operation and 1 case of postoperative infection with titanium-plate fracture.All of them were cured after active surgical treatment.Conclusion: Both the 2 approaches can effectively cure tuberculosis of single segment lumbar tuberculosis,and they are safe and effective surgical methods.the number of postoperative drainage volum in lateral anterior extraperitoneal approach is less than posterior,and group A shows less than group B in the bed time after operation,but group B shoes better than group A on orthopaedic effect. |
PDF Full Text Request