一期前路病灶清除钛网植骨内固定术治疗胸椎及胸腰段结核

One stage anterior debridement and titanium mesh instrumentation for thoracic and thoracolumbar tuberculosis

中文关键词:  结核  脊柱  骨移植  内固定

英文关键词:Tuberculosis  Spinal surgery  Bone transplantation  Internal fixation

中文摘要:

  【摘要】 目的：探讨一期前路病灶清除钛网植骨内固定术治疗胸椎及胸腰段脊柱结核的疗效。方法：2003年4月～2007年3月共收治胸椎及胸腰段脊柱结核患者31例，男17例，女14例；年龄21～72岁，其中65岁以上患者5例。胸椎（T4～T10）结核13例，胸腰段（T11～L2）结核18例，单节段6例，2节段21例，3节段4例，无跳跃病灶。所有患者均有相应病变部位疼痛不适，疼痛视觉模拟（VAS）评分平均7.4±0.5分；13例有神经功能损害，Frankel分级A级4例，B级3例，C级2例，D级4例；术前后凸Cobb角平均25.3°±8.2°，其中后凸Cobb角在30°以上者9例；病变椎体后壁破坏侵蚀至椎管者13例，椎体后壁结构完整者18例。均采用一期前路病灶清除、钛网植骨及前路内固定治疗，随访观察治疗效果。结果：手术时间平均3h，术中出血平均400ml，所有患者伤口均获一期愈合，术后胸腔积液1例，经穿刺抽液治愈；无肺部感染、呼吸衰竭等并发症发生。术后2周患者症状明显缓解并开始下床活动。13例有脊髓功能损害者，术后神经功能均有1级以上改善。随访24～72个月，平均41个月。患者疼痛均明显改善，末次随访时VAS评分平均2.0±1.2分，与术前比较有显著性差异（P＜0.05）。术后1周时后凸Cobb角平均6.5°±3.1°，矫正率为（74.3±15.1）%，至末次随访时矫正角度丢失1.5°±1.0°。所有患者内固定位置良好，无松动、断裂等并发症，结核均治愈，无复发，植骨均获融合，融合时间3～6个月，平均4.3个月。结论：一期前路病灶清除钛网植骨内固定治疗胸椎及胸腰段脊柱结核能有效地矫正脊柱畸形，解除脊髓压迫，重建脊柱稳定性，促进植骨融合，缩短卧床时间，提高脊柱结核的治愈率。

英文摘要:

  【Abstract】 Objective：To evaluate the effect of one stage anterior debridement and titanium mesh instrumentation for thoracic and thoracolumbar tuberculosis.Method：31 cases of thoracic and thoracolumbar tuberculosis undergoing anterior debridement and decompression，interbody fusion with titanium mesh instrumentation from April 2003 to March 2007 were reviewed retrospetively.The were 17 males and 14 females with the age ranging from 21 to 72 years，of these，5 were older than 65 years.Thoracic tuberculosis was noted in 13 cases and thoracolumbar tuberculosis in 18 cases.Among them，6 cases had 1 vertebra involved，21 cases had 2 vertebrae and 4 cases had 3 vertebrae involved with no jumping lesions.All patients presented with local pain and 13 patients presented with paralysis，the average VAS score was 7.4±0.5.According to Frankel grade system，4 cases were grade A，3 were grade B，2 were grade C and 4 were grade D.The average preoperative Cobb angle was 25.3°±8.2° with 9 patients′ preoperative Cobb angle larger than 30°，13 cases had posterior wall of involved vertebrae penetrated while 18 cases remained integrity.The surgical outcome was evaluated retrospectively.Result：The average surgical time was 3h，and the mean blood loss was 400ml.All incisions healed primarily，one patient was complicated with pleural effusion which was cured by thoracentesis.No pulmonary infection or respiratory failure was noted.All patients had symptoms relieved and all recovered to ambulate at 2 weeks after operation.All 31 cases were followed up from 24 to 72 months with an average of 41 months.No instrument failure were noted either and all patients got solid bony union with the average fusion time of 4.3 months（range，3-6 months）．The average correction rate of the kyphosis deformity was （77.1±15.1）% （preoperative Cobb angle 15.3°±5.2°，postoperative Cobb angle 3.5°±2.1°） with an average loss of correction of 1.5°±1.0° at follow-up.The mean VAS score improved from 7.4±0.5 to 2.0±1.2.The Frankel scale of 13 patients with paraplegia improved at least one grade．Conclusion：One stage anterior debridement and titanium mesh instrumentation for thoracic and thoracolumbar tuberculosis can ensure good correction of the kyphosis deformity，completely decompression as well as stability reconstruction，which have a good prognosis．