改良一期后入路术式治疗胸椎结核的临床分析  

Single-stage treatment for thoracic tuberculosis using an improved posterior approach

作　　者：胡资兵[1] 曾荣[1] 孙欣[1] 孟庆奇[1] 陈思圆[1] 孙杰聪[1] 陈海聪[1] 

机构地区：[1]广东医学院附属医院骨科,湛江524001

出　　处：《中国矫形外科杂志》2014年第17期1584-1588,共5页Orthopedic Journal of China

摘　　要：[目的]探讨改良一期后入路病灶清除、抗生素/磷酸钙骨粉填充和椎弓根内固定手术治疗胸椎结核的临床疗效。[方法]回顾性分析70例胸椎结核患者两种不同手术治疗方法的临床资料,其中男29例,女41例;年龄19-78岁,平均39岁。治疗组35例采用改良后入路病灶清除、抗生素/磷酸钙骨粉填充和椎弓根内固定;对照组35例患者采用经前路病灶清除、自体肋骨植入和椎体钉棒固定。术后平均随访时间24个月。病变累及两个或两个以上椎体。58例患者有不同程度脊柱后凸畸形,后凸角12°-55°,平均32°。48例伴有神经功能障碍,术前正规抗痨治疗2-3周,术后正规抗痨治疗12-18个月;随访分析两组患者植骨融合情况、神经功能恢复和后凸畸形矫正情况。[结果]术后患者胸背痛症状均有明显改善,未出现脊髓损伤和肋间神经损伤现象。术后1-2个月红细胞沉降率逐渐恢复正常。影像结果显示病人的脊柱后凸畸形得到不同程度的矫正：对照组28例术后后凸角度矫正至平均17°,治疗组30例术后后凸角度矫正至平均8°（P〈0.05）。所有患者椎间植骨获骨性愈合,治疗组愈合时间为3-9个月,平均5个月;对照组骨性愈合时间4-10个月,平均6个月（P〉0.05）。48例伴神经功能障碍者,术后Frankel分级提高1-2级。对照组术后发生胸腔积液3例、气胸1例、切口感染1例,对症处理后痊愈。末次随访病例无复发,脊柱病变节段稳定。[结论]改良一期后路病灶清除和抗生素/磷酸钙骨粉填充植骨、内固定治疗胸椎结核是一种有效的手术方式,具有创伤小、脊柱重建稳定、有效矫正和防治继发性脊柱后凸畸形等优点。[Objective] To explore the clinical effects of improved single-stage posterior debridement combined with pedicle screw internal fixation and bone fusion using antibiotic /calcium phosphate for the treatment of thoracic tuberculosis. [Methods] We performed a retrospective analysis using clinical data of 70 patients with thoracic tuberculosis（ 29 male and 41 female;age： 19 - 78 years,mean age： 39 years） who underwent two different operations. Single-stage posterior debridement with pedicle screw internal fixation and bone fusion were performed in 35 patients in the treatment group,and anterior debridement with autogenous rib grafts and vertebral pedicle screw fixation were performed in the remaining patients in the control group. All patients underwent a follow-up for an average of 24 months,and more than two vertebral bodies were involved. Fifty-eight patients had varying degrees of kyphosis,with a kyphosis angle of 12° - 55°（ average,32°）. Neurological deficits were found in48 patients. Before surgery,patients received standard anti-tuberculosis chemotherapy for 2 - 3 weeks. Anti-tuberculosis chemotherapy was continued for 12 - 18 months after surgery. Follow-up data were analyzed to determine neurological improvement,the fusion rate,and recovery from kyphosis. [Results] Chest and back pain had significantly alleviated in all patients. No spinal cord and intercostal nerve damage was observed. Erythrocyte sedimentation rates of these patients reduced 1month after the operation,and normal rates were achieved 2 months later. Postoperative imaging results showed that kyphosis was partly corrected. The deformity was corrected from an average of 32° to an average of 8° after surgery in 30 patients with preoperative kyphosis in the treatment group,but kyphosis was corrected only to an average of 17° in the 28 patients in the control group（ P 〈0.05）. Solid bone fusion was achieved in all patients. The time taken for bone graft fusion in the treatment group was 3-9 months（ average,5 months）,and

关 键 词：后入路术式 胸椎结核 病灶清除 植骨融合 椎弓根内固定 

分 类 号：R687.3[医药卫生—骨科学]