一期后路病灶清除椎体钉内固定治疗中上胸椎结核  

One-stage posterior debridement and transvertebra screw instrumentation for middle-upper thoracic spinal tuberculosis

作　　者：姜传杰[1] 杨永军[1] 谭远超[1] 张恩忠[1] 姚树强[1] 于建林[1] 

机构地区：[1]山东省文登整骨医院脊柱脊髓科,文登市264400

出　　处：《中国脊柱脊髓杂志》2010年第4期326-330,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨一期后路病灶清除椎体钉内固定治疗中上胸椎结核的临床效果。方法:2006年4月～2009年11月,采用一期后路病灶清除椎体钉内固定治疗中上胸椎结核患者19例,其中T2～T32例,T3～T56例,T5～T811例。17例存在明显的脊髓神经功能损害,按Frankel分级,B级3例,C级6例,D级8例,E级2例。术前后凸畸形Cobb角为24°～53°,平均32.4°。根据患者手术时间、Frankel分级、后凸Cobb角、骨融合、内固定物失效、血沉变化及结核复发等情况评价手术治疗结果。结果:19例患者平均手术时间为225.4±26.7min,全部病例随访1.5～3年(平均20.7个月)。9例术前合并有神经功能损害患者神经功能有不同程度的恢复。无肋间神经损伤病例。术后脊柱后凸畸形Cobb角矫正至5°～17°,平均12°。术后6～12个月(平均6.8个月)椎间植骨达到骨性融合,未发现假关节形成。无一例内固定物出现断裂、松动、脱落。血沉均在2周后明显下降,在2～3个月内基本恢复正常。1例患者颈前结核脓肿复发,后另行颈前结核脓肿切除术后痊愈。结论:一期后路病灶清除椎体钉内固定可彻底清除病灶,椎体钉置钉安全性高,固定切实可靠,适合大部分中上胸椎结核的治疗。Objective：To investingate the surgical efficacy of one-stage posterior debridement and transvertebra screw instrumentation for middle-upper thoracic spinal tuberculosis.Method：From April 2006 to November 2009,19 patients with middle-upper thoracic spinal tuberculosis were treated by posterior debridement and transvertebra screw instrumentation.Of these,2 cases had lesion at T2-T3,6 at T3-T5 and 11 at T5T8.17 cases were complicated with neurological deficit.According to the Frankel scale system,3 were in grade B,6 in grade C,8 in grade D and 2 in grade E.The average preoperative kyphosis Cobb angle was 32.4°（range,24°-53° ）.The operation time,Frankel grade,kyphosis Cobb angle,bony union,hardware failure,ESR value and tuberculosis recurrence were evaluated.Result：The average operation time was 225.4±26.7min.All 19 patients were followed up for 1.5-3 years.9 cases with neurological deficit recovered to different extent.No case was complicated with intercostal nerve injury.The average kyphosis Cobb angle was corrected to 12°（range,5°-17°） after surgery.Satisfactory intervertebral bony fusion was evidenced in all cases with no pseudoarticulation formation and hardware failure.Erythrocyte sedimentation rate（ESR） started to decrease at 2 weeks after operation,and to become nearly normal two or three months later.One case was complicated with tuberculosis recurrence at anterior side of cervical spine,which was cured by additional excision of abscess.Conclusion：One-stage posterior debridement and transvertebra screw instrumentation is effective and reliable for most of the middle-upper thoracic spinal tuberculosis,which can secure complete debridement and safe screw placement.

关 键 词：中上胸椎结核 病灶清除 椎体钉 

分 类 号：R529.2[医药卫生—内科学]