胸椎结核外科治疗不同术式选择探讨  

Surgical Outcome and Strategy in the Treatment of Thoracic Spinal Tuberculosis

作　　者：杨永辉[1] 蔡玉强[2] 晁建虎 王少飞[1] 雷小平[1] 

机构地区：[1]宝鸡市中医医院脊柱外科,陕西宝鸡721000 [2]遵义医学院附属医院脊柱外科,贵州遵义563000

出　　处：《实用骨科杂志》2014年第9期788-794,共7页Journal of Practical Orthopaedics

摘　　要：目的探讨不同解剖节段胸椎结核外科治疗术式的选择策略及疗效。方法回顾分析2005年5月至2009年5月手术治疗36例成人胸椎结核的临床资料,其中男19例,女17例;年龄17～60岁,平均32.2岁;病变破坏2个椎体23例,3个椎体7例,4个椎体6例。术前所有患者均有不同程度的后凸畸形,后凸角10°～110°,平均21°。22例伴有神经功能障碍。将胸椎按照解剖特点分为颈胸结合部（C7～T2）、中部（T3～5）、下胸椎（T6～12）。依据解剖特点不同采用5种不同的手术入路（颈胸结合部前入路、经胸腔胸膜外入路、开胸、肋横突旁入路、后正中入路）对36例胸椎结核患者行一期病灶清除、植骨融合内固定术。结果所有患者随访18～48个月,平均26个月,术后胸背部疼痛减轻,切口一期愈合,术后1～3个月血沉逐渐恢复正常,术后后凸角度矫正至0°～60°,平均14°,自体骨植骨于术后3个月开始融合,22例伴有神经功能障碍者,术后Frankel分级提高1～2级,大部分完全恢复。结论根据胸椎结核病灶部位的解剖特点、累及的范围选择恰当的术式可有效清除结核病灶,矫正后凸畸形,重建脊柱的稳定性,改善神经功能,临床效果良好。Objective To investigate surgical strategy and outcome for thoracic tuberculosis. Methods Data of 36 pa-tients,who had undergone surgical treatment for thoracic spinal tuberculosis from May 2005 to May 2009,were retrospectively analyzed. There were 18 cases of male and 18 cases of female;age 17 ～ 60 years old with an average of 32. 2 years. The lesion level was T1 ～ 12 ,including two levels in 23 cases,three levels in 7 cases,four levels in 6 cases. All patients had varying degrees of kyphosis,kyphosis angle 10° ～ 110°,an average of 21°. Twenty-two patients with neurological deficits. Three antaomical re-gions were defined：cervicothoracic junction（C7 ～ T2 ）;middle thoracic spine（T3 ～ 5）and subaxial thoracic spine（T6 ～ 12 ）. The patients with thoracic tuberculosis were treated by 5 different surgical procedures（anterior cervicothoracic,anterior radical debridement by extrapleural approach,anterior radical debridement by transthoracic approach,posterolateral decompression, posterior）. The tuberculous lesion region was completely resected,autologous iliac or rib graft was harvested to complete inter-body fusion,and an instrumentation was used to reconstruct the stability of the affected segments. Results All patients were followed up for 18 ～ 48 months postoperatively,with the average of 26 months. All patients＆#39; . Erythrocyte sedimentation rate gradually returned to normal after 1 to 3 month. The deformity was corrected to posterior correct angle to 0° ～ 60°,an average of 14°36 patients with preoperative kyphosis. Twenty-two patients with neurological deficits showed obvious improvement. Conclu-sion For patients with thoracic tuberculosis,the surgical methods should be chosen according to the anatomical region and de-gree of the lesion.

关 键 词：胸椎结核 手术策略 脊柱融合术 外科手术 

分 类 号：R529.2[医药卫生—内科学]