后前路手术中应用病椎间与超病椎间固定治疗儿童胸腰椎结核的疗效观察

Curative observation for the application of the combined posterior and anterior instrumentation at lesion or non-lesion vertebral for pediatric thoracolumbar tuberculosis

中文关键词:  儿童  胸腰椎结核  后前路手术  病椎间固定

英文关键词:Children  Thoracolumbar tuberculosis  Combined posterior and anterior surgical  Diseased segment fixation

中文摘要:

  【摘要】 目的：探讨后前路手术治疗儿童胸腰椎结核的效果，并观察病椎间或超病椎间固定时相邻节段（未施行融合术）自发融合的发生情况。方法：2000年4月～2011年5月采用后前路手术方式治疗并获得完整随访资料的儿童胸腰椎结核患者23例，其中男11例，女12例，平均年龄11.2±0.6岁（7～14岁）。所有患者均有不同程度的椎体破坏及后凸畸形；21例有脓肿形成；8例合并神经功能障碍（Frankel分级C级3例，D级5例）。手术方法为后路病椎间或超病椎间椎弓根螺钉内固定、病椎间后外侧植骨融合，前路彻底病灶清除、减压、病椎间髂骨支撑植骨融合。病椎间固定（病变未累及椎弓根者）17例，超病椎间固定6例，术后均行超短程化疗。对患者后凸角、血沉及C-反应蛋白的变化情况、植骨融合情况、Frankel分级等进行综合评价。结果：所有患者术后平均随访68.43±23.40个月（36～120个月）。所有患者的血沉及C-反应蛋白在术后6个月均恢复正常。前中柱植骨愈合时间平均4.26±0.81个月。病椎间固定者，后凸畸形矫正率（72±5）%，末次随访丢失1.29°±0.85°；病变共累及28个节段，固定融合28个节段，末次随访共30个节段的小关节融合，自发性融合2个节段。超病椎间固定者，后凸畸形矫正率（77±6）%，末次随访丢失1.00°±1.10°；病变共累及10个节段，固定22个节段，手术融合10个节段，末次随访共25个节段的小关节融合，自发性融合15个节段。8例神经功能障碍者末次随访时Frankel分级均达到E级。结论：后前路手术治疗儿童胸腰椎结核疗效优良，病变未累及椎弓根者采用病椎间固定可以减少未施行融合的相邻节段自发融合的发生。

英文摘要:

  【Abstract】 Objectives: To investigate the effects of the combined posterior and anterior sugery treatment for thoracolumbar tuberculosis in children, and to observe the adjacent segment′s spontaneous fusion with the instrumentation at or/not diseased level. Methods: 23 children suffered from thoracolumbar tuberculosis were involved in our study, including 11 males and 12 females, all cases had an average age of 11.2±0.6 years (range, 7-14 years). All cases had varying degrees of destruction of vertebral body and kyphosis deformity, 21 cases with abscess formation, 8 cases with nerve dysfunction(Frankel grade: 3 in C, 5 in D). All of them received posterior instrumentation at or/not diseased level, posterolateral fusion, anterior radical debridement, decompression and interbody iliac strut bone graft, and all cases were retrospectively reviewed from April 2000 to May 2011 in our department. 17 cases underwent diseased level instrumentation, and 6 cases underwent instrumentation across the diseased level, and all cases were given the ultra-short-course chemotherapy after operation. The changes of the kyphosis angle, ESR and CRP of all cases were observed. Comprehensive evaluation of fusion status and Frankel grade were also performed in the study. Results: The average duration of the follow-up was 68.43±23.40 months(36-120 months). The ESR and CRP of all cases returned to normal 6 months after operation. The average bone union time at anterior and middle columns was 4.26±0.81 months. In the cases with diseased level instrumentation, the average correction rate of kyphosis was (72±5)%, with the loss of correction of 1.29°±0.85°, a total of 28 diseased levels was fixed and fused, and a total of 30 segments got fusion at final follow-up, the spontaneous fusion was noted in 2 segments. In the cases with instrumentation across the diseased level, the average correction rate was (77±6)%, with the loss of correction of 1.00°±1.10°, a total of 10 segments was fixed and fused, while a total of 25 segments got fusion at final follow-up, the spontaneous fusion was noted in 15 segments. 8 cases with neurological deficit recovered to Frankel grade E at final follow-up. Conclusions: The combined posterior with anterior surgery is reliable for pediatric thoracolumbar tuberculosis, which can effectively maintain the growth balance between the anterior column and posterior column of diseased vertebra. Instrumentation at diseased level can decrease the incidence of spontaneous fusion at adjacent nonsurgical segment.