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

作　　者：张宏其[1] 唐明星[1] 郭超峰[1] 刘少华[1] 王昱翔[1] 邓盎[1] 刘金洋[1] 吴建煌[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,湘雅脊柱外科中心,长沙市410008

出　　处：《中国脊柱脊髓杂志》2012年第7期617-621,共5页Chinese Journal of Spine and Spinal Cord

基　　金：湖南省科技厅科技计划一般项目资助(项目编号:2009JT4011);湖南省科技厅科技计划重点项目(项目编号:05SK2004)

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。Objectives： To investigate the effect and feasibility of posterior debridement, bony graft and in- strumentation 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 av- erage 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 ab- scess was noted in all cases. All cases underwent posterior debridement, bony graft and instrumentation. Re- suits： 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 fail- ure 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.

关 键 词：上胸椎 脊柱结核 病灶清除 椎体间植骨 内固定 后路 

分 类 号：R681.5[医药卫生—骨科学]