微创直接外侧入路椎间融合术治疗胸腰椎结核

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Abstract Objective To investigate the clinical effect of debridement，bone autograft and internal fixation via minimally invasive direct lateral approach for thoracolumbar spinal tuberculosis.Methods A retrospective analysis was made on the clinical data of 35 patients(male 16 case，female 19 case) with thoracic and lumbar spinal tuberculosis undergoing debridement，bone autograft and internal fixation via invasive direct lateral approach from January 2013 to January 2015，which was compared with data of 27 patients with thoracic and lumbar spinal tuberculosis undergoing debridement，bone autograft and internal fixation via traditional anterolateral approach from January 2010 to December 2012.There were no significant differences between two groups in generalinformation(P＞0.05).The length of incision，operation time，perioperative blood loss，postoperative hospitalization time，complications and postoperative VAS were compared.The rate of bone graft fusion was judged according to Suk standard.Results All patients were followed up for 12～72 months postoperatively(mean 28.5 months).There were significant statistical differences in length of incision，perioperative blood loss，postoperative hospitalization time between the two groups，but no significant statistical difference in operation time.Back pain VAS improved obviously after operation in two group.There were significant statistical differences in back pain On 1 day，7days，1 month after operation，but there was no significant statistical difference on 3 months VAS between two group.The fusial rate of min-open group was 91.4%，and was 92.6% in traditional group.There was no significant statistical difference in fusional rate between two group.There were 3 cases had transient proximal lower extremity numbness，5 cases had immediate postoperative ipsilateral iliopsoas weakness in min-open group，and 1 cases had transient proximal lower extremity numbness，3 cases had immediate postoperative ipsilateral iliopsoas weakness in traditional group，which recoverd spontaneously from 1 to 3 months after operation.There were 1 case of incision related complication and 1 case of tuberculosis recurrence on 3 months after operation in min-open group.There were 1 case of incision related complication and 1 case of tuberculosis recurrence and instrumental loosening on 5 months after operation in traditional group.Conclusion Compare with traditional anterolateral approach，minimally invasive direct lateral approach have the advantages of minimal invasion，less bleeding，quicker recovery，which is a safe and effective treatment for thoracic and lumbar spinal tuberculosis.

Key words： minimally invasive surgery direct lateral interbody fusion spinal tuberculosis

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