非跳跃性胸椎结核外科治疗的术式选择和疗效分析  

The operative option and therapeutic effect in the treatment of multiple-level contiguous thoracic spinal tuberculosis

作　　者：崔旭[1] 马远征[1] 陈兴[1] 李宏伟[1] 才晓军[1] 郭立新[1] 薛海滨[1] 胡明[1] 

机构地区：[1]北京解放军第309医院全军骨科中心,100091

出　　处：《中华骨科杂志》2013年第2期123-129,共7页Chinese Journal of Orthopaedics

摘　　要：目的回顾性分析81例成人非跳跃性胸椎结核的手术疗效，探讨非跳跃性胸椎结核手术入路、固定方式的选择策略。方法2001年1月至2010年12月采用5种不同的手术方法治疗胸椎结核患者112例，81例成人非跳跃性胸椎结核患者获得平均39个月（17-75个月）的随访，其中23例合并脊髓功能障碍，Frankel分级A级3例、B级4例、C级7例、D级9例。以双椎体结核多见，尤以T10、T11最多。结果所有患者术后1-3周局部症状均明显减轻，术后8～12周红细胞沉降率恢复正常，无严重的并发症发生。23例伴有脊髓损害的患者脊髓功能Frankel分级至少提高1级。3例患者分别于术后0．5、1和1．5个月出现切口窦道形成，经CT及MR检查无脓肿、死骨形成，经换药治疗1-2个月后治愈。前路固定组脊柱后凸畸形矫正率平均为10．2°±2．1°，后路固定组平均为12．6°±2．7°，差异有统计学意义；末次随访时前路固定组矫正角度丢失平均为6．9°±1．9°，后路固定组为5．8°±1．4°，差异有统计学意义。结论成人非跳跃性胸椎结核的术式选择应根据病变的部位、范围以及患者的一般状态而定，采用正确的手术方式能够达到矫正脊柱后凸畸形、清除病灶、脊髓减压及缓解局部疼痛的目的，后路固定在矫正脊柱后凸畸形及维持矫形方面要优于前路固定。Objective To investigate operative approach, immobilization manner, and surgical effect of muhiple-level contiguous thoracic spinal tuberculosis. Methods Between January 2001 and December 2010, 112 patients with thoracic spinal tuberculosis were treated with 5 different surgical procedures. Among them, 81 adults with multiple-level contiguous thoracic spinal tuberculosis were followed up for 17 to 75 months （average, 39 months）. Twenty three patients suffered from spinal cord dysfunction; according to the Frankel classification, there were 3 cases of type A, 4 cases of type B, 7 cases of type C, and 9 cases of type D. The double vertebral bodies were commonly affected areas, especially T10 and T11. Results Local symp- toms of all patients were relieved significantly 1 to 3 weeks postoperatively. Erythrocyte sedimentation rates （ESR） returned to normal level in all patients 8 to 12 weeks postoperatively. Three sinuses were found 0.5 month, 1 month and 1.5 months postoperatively, respectively, which were cured by changing dressing for 1 to 2 months. The average correction of kyphotic deformity was 10.2°±2.1° in anterior fixation group, while 12.6°±2.7° in posterior fixation group. At final follow-up, the average loss of correction was 6.9°±1.9° in an- terior fixation group, while 5.8°±1.4° in posterior fixation group. At least one Frankel grade improvement was observed in 23 patients. Conclusion The surgical methods should be chosen according to the location and degree of the lesion. Correct surgical procedures can obtain good results in correction and maintenance of the deformity, clearance of the loci, decompression of the spinal cord and pain relief for thoracic spinal tu- berculosis. The posterior fixation is better than the anterior fixation with regard to correction and mainte- nance of the kyphotic deformity.

关 键 词：胸椎 结核 脊柱 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]