一期前路手术治疗下颈椎结核并后凸畸形的5年以上随访结果

One-stage anterior approach for lower cervical spinal tuberculosis complicated with kyphosis，a study of over 5 year follow-up

中文关键词:  结核  下颈椎  后凸畸形  手术治疗  疗效

英文关键词:Tuberculosis  Lower cervical spine  Kyphosis deformity  Operation  Therapeutic effect

中文摘要:

  【摘要】 目的：观察一期前路病灶清除植骨内固定手术治疗下颈椎结核合并后凸畸形的5年以上随访结果。方法：2003年10月~2006年4月，采用一期前路病灶清除自体髂骨植骨钢板内固定手术治疗下颈椎结核合并后凸畸形患者15例，男9例，女6例，年龄25～58岁，平均39岁。结核病灶共累及32个椎体，其中累及2个椎体13例（4例C3～C4、3例C4～C5、5例C5～C6、1例C6～C7），3个椎体2例（1例C3～C5、1例C4～C6）。术前颈部疼痛VAS评分6～10分，平均8分；神经功能按Frankel分级B级2例，C级4例，D级7例，E级2例；颈椎后凸Cobb角15°～50°，平均28.0°。术前、术后抗结核药物治疗总疗程为10～15个月，平均12个月。结果：1例术后第2天出现喉头水肿、呼吸困难，经对症处理症状消失。随访61～88个月，平均72个月。颈部疼痛VAS评分术后1周为1～5分，平均3.5分，与术前比较有显著性差异（P＜0.01）；术后1年0～1分，平均0.4分，较术后1周明显降低（P＜0.05）；末次随访时0～4分，平均2分，较术后1年时明显增加（P＜0.05）。末次随访时，13例术前有神经症状患者中9例Frankel分级改善1级，4例改善2级。颈椎后凸Cobb角术后1周为-8°～2°，平均为-2.4°，与术前比较有显著性差异（P＜0.01）；末次随访为-7°～2°，平均-2.1°，与术后1周比较无显著性差异（P＞0.05）。均获骨性融合，融合时间为3～8个月，平均4.5个月。3例术后出现取髂骨处疼痛，末次随访仍有1例诉髂骨供区不适。末次随访时，6例出现相邻节段椎体和椎间盘退行性改变，3例植骨块下沉（下沉均小于2mm），无内固定松动、断裂。末次随访时均无结核病复发。结论：对下颈椎结核合并后凸畸形患者，在正规抗结核药物治疗基础上积极进行一期前路结核病灶清除、自体髂骨植骨钢板内固定矫形手术，5年以上随访结果显示效果良好。

英文摘要:

  【Abstract】 Objective：To observe the minimun five-year follow-up of one-stage anterior debridement，autograft and instrumentation for lower cervical spinal tuberculosis（TB） complicated with kyphosis.Method：15 cases suffering from lower cervical spinal TB complicated with kyphosis（9 males and 6 females with the average age at operation of 39 ranging from 25 to 58） underwent one-stage anterior debridement，autograft and instrumentation from October 2003 to April 2006.A total of 32 vertebrae were involved（2 vertebrae in 13 cases and 3 vertebrae in 2 cases）.The defect sites were C3-C4 in 4 cases，C4-C5 in 3 cases，C5-C6 in 5 cases，C6-C7 in 1 case，C3-C5 in 1 case and C4-C6 in 1 case.The average neck pain VAS score was 8（range，6-10） before surgery，and the preoperative Frankel grade included 2 grade B，4 grade C，7 grade D，2 grade E.The average preoperative Cobb angle was 28.0°（range，15°-50°）.Anti-TB chemotherapy treatment was performed for 10 to 15 months perioperatively（12 months on average）.Result：Laryngeal edema was found in one patient one day after surgery，and healed after corresponding intervention.All 15 cases were followed up for an average of 72 months（range，61-88 months）.Neck pain VAS scores were 1-5（average，3.5） at 1 week after operation，which were significantly lower than preoperative ones（P＜0.01）；0-1（average，0.4） at 1 year after operation，which were significantly lower than the 1 week ones（P＜0.05）；and 0-4（average，2） at final follow-up.Neck pain VAS scores at 1 year were significantly lower than the final follow-up ones（P＜0.05）.Of 13 cases with neurological deficit，9 patients had Frankel grade improved 1 level，and 4 patients had it improved 2 levels.The average Cobb angle of cervical spine was -2.4°（range，-8°-2°） one week after operation，which was significantly lower than preoperative one（P<0.01）；and -2.1°（range，-7°-2°） at final follow-up，which remained no change with 1 week one（P>0.05）.Solid bone fusion was achieved in all patients with the average fusion time of 4.5 months（range，3-8 months）.3 patients complained of pain in bone donor site，and no pain relief was noted in 1 till final follow-up.Adjacent segment degeneration was found in 6 patients and less than 2mm of autograft subsidence was found in three cases.No instrument failure and no recurrence of tuberculosis were noted at final follow-up.Conclusion：The results of minimum 5-year follow-up show reliable outcome of one-stage anterior debridement，autograft and instrumentation for lower cervical spinal tuberculosis complicated with kyphosis on the basis of standard anti-TB chemotherapy medicine.