单纯经后路内固定病灶清除椎体间植骨治疗上胸段脊柱结核

Posterior debridement, bony graft and instrumentation for upper thoracic tuberculosis

中文关键词:  上胸椎  脊柱结核  病灶清除  椎体间植骨  内固定  后路

英文关键词:Upper thoracic vertebrae  Spinal tuberculosis  Interbody bone graft  Internal fixation  Posterior approach

中文摘要:

  【摘要】 目的：探讨单纯经后路内固定、病灶清除、椎体间植骨治疗上胸段脊柱结核的疗效。方法：2006年5月~2011年4月治疗14例上胸段脊柱结核患者，男6例，女8例；年龄18～67岁，平均37岁， ASIA分级：A级1例，B级2例，C 级5例，D级3例，E级3例。病变节段后凸角度26°～55°，平均37°。结核病灶累及范围：T1～T2 1例，T2～T3 4例，T3～T4 5例，T4 2例，T4～T5 2例，受累椎体均在2个或2个以下，且病灶相对局限，无大的流注脓肿。均采用单纯单纯经后路内固定、病灶清除、椎体间植骨术式治疗。术后继续抗结核治疗12～18个月。随访观察治疗效果。结果:手术时间140～270min，平均195min，术中失血量300～2500ml，平均850ml。术后随访6～48个月，平均18个月。2例患者出现脑脊液漏，1例患者并发硬膜外血肿，1例患者伤口延迟愈合。无窦道形成，无感染性脑脊髓膜炎发生。植骨融合时间为3～8个月，平均5个月。所有患者内固定位置良好，无松动、断裂等并发症。末次随访时11例有脊髓神经功能损伤者ASIA分级改善1～2级。术后后凸角度6°～18°，平均10°，平均矫正27°，后凸角度矫正率为73.0%，末次随访矫正角度丢失平均2°，无结核复发。结论：对于病灶较局限的上胸段脊柱结核，采用单纯经后路内固定、病灶清除、椎体间植骨的手术方式可以达到较满意的治疗效果。

英文摘要:

  【Abstract】 Objectives: To investigate the effect and feasibility of posterior debridement, bony graft and instrumentation for upper thoracic tuberculosis. Methods: 14 cases suffering from upper thoracic tuberculosis were admitted to our hospital from May 2006 to April 2011. There were 6 males and 8 females, with an average age of 37 years(range, 18 to 67 years). Based on preoperative ASIA score, there were 1 grade A, 2 grade B, 5 grade C, 3 grade D, and 3 grade D. The kyphosis angel of diseased segments was 26° to 55°(mean, 37°). The involved segments included: T1 to T2 in 1 case, T2 to T3 in 4, T3 to T4 in 5, T4 in 2，and T4 to T5 in 2, and the involved vertebrae were less than two. The defects were limited in local, no abscess was noted in all cases. All cases underwent posterior debridement, bony graft and instrumentation. Results: The operation time ranged from 140min to 270min, 195min in average. The blood loss ranged from 300 to 2500ml, 850ml in average. The follow-up was 6 to 48 months, 18 months in average. 2 cases were complicated with CSF leakage, there was extradural hematoma in 1 case and delayed union of wound in 1 case. Sinus tract, cerebrospinal meningitis and recurrence of tuberculosis were not noted. No instrumental failure was noted. ASIA score improved by 1.14 grades in average. The ESR recovered to normal 6 months after operation in all patients. Solid fusion was achieved within 3 to 8 months, with an average of 5 months. The mean kyphosis angle was 10°(range, 6° to 18°) after operation， with an average correction rate of 73.0%. At final follow-up, the average loss of correction was 2°. Conclusions: Posterior debridement, bony graft and instrumentation is reliable and safe for upper thoracic tuberculosis with localized defect.