皮质骨轨迹螺钉内固定对老年腰椎结核患者术后康复的影响

doi:10.3969/j.issn.1000-6621.2021.05.007

摘要/Abstract

摘要：

目的探讨皮质骨轨迹螺钉(cortical bone trajectory,CBT)内固定对老年腰椎结核患者加速康复外科(enhanced recovery after surgery,ERAS)的影响。方法选取2019年1月至2020年1月浙江大学医学院附属杭州市胸科医院收治的78例手术治疗的老年腰椎结核患者,根据内固定不同分为CBT组和传统组,所有患者均按照ERAS管理。其中2019年7月至2020年1月患者为CBT组,共38例,男21例,女17例,平均年龄(73.95±5.30)岁;平均骨密度T值(-2.34±0.46);单节段椎体破坏30例,两节段椎体破坏8例;并发糖尿病12例,并发高血压16例,并发肺结核27例。2019年1—6月为传统组,共40例,男23例,女17例,平均年龄(73.75±5.02)岁;平均骨密度T值(-2.22±0.40);单节段椎体破坏34例,两节段椎体破坏6例;并发糖尿病13例,并发高血压15例,并发肺结核30例。比较两组患者手术时间、术中出血量、术后24h VAS评分、术后卧床时间、住院时间及术后并发症发生率。结果 CBT组手术时间[(231.34±8.57)min]、术中出血量[(483.34±58.90)ml]、术后24h VAS评分[(4.11±0.83)分]、术后卧床时间[(7.32±1.85)d]、住院时间[(21.82±4.57)d]均低于传统组[(246.98±11.81)min]、[(517.48±37.16)ml]、[(5.10±1.06)分]、[(8.33±1.62)d]、[(24.38±3.25)d],差异均有统计学意义(t值分别为-6.664、-3.077、-4.601、-2.567、-2.863,P值分别为0.000、0.003、0.000、0.012、0.005)。CBT组并发症发生率为2.6%(1/38),传统组并发症发生率为7.5%(3/40)(χ²=0.949,P=0.330)。结论 CBT螺钉内固定对老年腰椎结核患者ERAS产生了积极影响,能明显减少手术出血量及手术时间,加速患者康复并缩短住院时间。

关键词: 结核,脊柱, 老年人, 内固定器, 外科手术, 快速康复, 对比研究

Abstract:

Objective To explore the effect of cortical bone trajectory (CBT) screw fixation on enhanced recovery after surgery(ERAS)in elderly patients with lumbar tuberculosis. Methods Seventy-eight elderly patients with lumbar tuberculosis who underwent surgical treatment from January 2019 to January 2020 in Hangzhou Chest Hospital were enrolled. The patients were divided into CBT group and traditional group according to internal fixation methods, and then managed with ERAS. Among them, there were 38 cases in the CBT group admitted from July 2019 to January 2020, including 21 males and 17 females, average age (73.95±5.30) years; average T value of bone mineral density was -2.34±0.46; 30 cases got single-segment vertebral destruction, 8 cases got two-segment vertebral destruction; 12 cases with diabetes mellitus, 16 cases with hypertension, and 27 cases with pulmonary tuberculosis. There were 40 cases in the traditional group admitted from January 2019 to June 2020, including 23 males and 17 females, average age (73.75±5.02) years; average T value of bone density was -2.22±0.40; 34 cases got single-segment vertebral body destruction, 6 cases got two-segment vertebral body destruction; 13 cases with diabetes mellitus, 15 cases with hypertension, 30 cases with pulmonary tuberculosis. The operation time, intraoperative blood loss, 24 h postoperative VAS score, postoperative bedding time, length of hospital stay and postoperative complications were compared between the two groups. Results The operation time ((231.34±8.57) min), intraoperative blood loss ((483.34±58.90) ml), 24 h postoperative VAS score (4.11±0.83), postoperative bedding time ((7.32±1.85) d), length of hospital stay ((21.82±4.57) d) in CBT group were significantly lower than the traditional group ((246.98±11.81) min), ((517.48±37.16) ml), (5.10±1.06), ((8.33±1.62) d), ((24.38±3.25) d), the differences between them were statistically significant (t values were -6.664, -3.077, -4.601, -2.567, -2.863,P values were 0.000, 0.003, 0.000, 0.012, 0.005 respectively). In addition, the complication rate in the CBT group was 2.6% (1/38), while 7.5% (3/40) in the traditional group (χ²=0.949,P=0.330). Conclusion CBT screw fixation has a positive effect on ERAS in elderly patients with lumbar tuberculosis, which can significantly reduce intraoperative blood loss and operation time, promote recovery and shorten the length of hospital stay.

Key words: Tuberculosis, spinal, Aged, Internal fixator, Surgery, ERAS, Comparative study

章鹏, 费骏, 石仕元, 胡德新, 陈根君, 张晨威, 王敏. 皮质骨轨迹螺钉内固定对老年腰椎结核患者术后康复的影响[J]. 中国防痨杂志, 2021, 43(5): 446-451. doi: 10.3969/j.issn.1000-6621.2021.05.007

ZHANG Peng, FEI Jun, SHI Shi-yuan, HU De-xin, CHEN Gen-jun, ZHANG Chen-wei, WANG Min. Effect of cortical bone trajectory screw fixation on postoperative rehabilitation of elderly patients with lumbar tuberculosis[J]. Chinese Journal of Antituberculosis, 2021, 43(5): 446-451. doi: 10.3969/j.issn.1000-6621.2021.05.007

图/表 4

表1

两组患者术前临床资料比较

临床资料	CBT组(38例)	传统组(40例)	统计检验值	P值
性别(例,男/女)	21/17	23/17	χ²=0.040	0.842
年龄(岁, $x ˉ$ ±s)	73.95±5.30	73.75±5.02	t=0.169	0.866
骨密度(T值, $x ˉ$ ±s)	-2.34±0.46	-2.22±0.40	t=-1.174	0.244
并发症[例(率,%)]
糖尿病	12(31.6)	13(32.5)	χ²=0.603	0.437
高血压	16(42.1)	15(37.5)	χ²=0.173	0.678
肺结核	27(71.1)	30(75.0)	χ²=0.154	0.694
病变节段数			χ²=0.485	0.486
1个[例,构成比(%)]	30(78.9)	34(85.0)
2个[例,构成比(%)]	8(21.1)	6(15.0)
术前VAS(分, $x ˉ$ ±s)	3.06±0.60	3.05±0.50	t=0.065	0.948

表1

图1~4

表2

两组患者手术时间、术中出血量、术后24h VAS评分比较

组别	例数	手术时间 (min, $x ˉ$ ±s)	术中出血量 (ml, $x ˉ$ ±s)	术后24h VAS评分 (分, $x ˉ$ ±s)
CBT组	38	231.34±8.57	483.34±58.90	4.11±0.83
传统组	40	246.98±11.81	517.48±37.16	5.10±1.06
t值		-6.664	-3.077	-4.601
P值		0.000	0.003	0.000

表2

表3

两组患者术后卧床时间与住院时间比较

组别	例数	术后卧床时间 (d, $x ˉ$ ±s)	住院时间 (d, $x ˉ$ ±s)
CBT组	38	7.32±1.85	21.82±4.57
传统组	40	8.33±1.62	24.38±3.25
t值		-2.567	-2.863
P值		0.012	0.005

表3

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