肩胛骨下胸腔入路治疗上胸椎结核  

Subscapularis transthoracic approach for upper thoracic tuberculosis

作　　者：林斌[1] 黎秋生 张毕[1] 郭志民[1] 

机构地区：[1]解放军第175医院骨科医院厦门大学附属东南医院,福建漳州363000

出　　处：《临床骨科杂志》2015年第6期645-648,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨肩胛骨下胸腔入路手术治疗上胸椎结核的临床价值。方法对21例上胸椎结核患者采用肩胛骨下经胸手术病灶清除、植骨融合、内固定治疗。结果手术时间为152-238（192±10）min;术中出血量600-1 800（1 150±235）ml。患者均获随访,时间6-48个月。2例术后出现肩关节活动障碍,经康复治疗,随访6个月后患者肩关节活动基本正常;2例术后出现肺部感染,抗感染治疗10 d后治愈。末次随访时,17例脊髓神经功能损伤者中,1例神经功能明显改善,16例神经功能均恢复至正常。术后Cobb角为19°-30°（24.8°±5.6°）,矫正率达30.9%。结论只要严格掌握手术适应证,肩胛骨下经胸内固定术治疗上胸椎结核减压彻底,脊柱稳定重建可靠,疗效肯定,具有较大临床价值。Objective To explore clinical value of the therapeutic effect of subscapularis transthoracic approach for upper thoracic tuberculosis. Methods A total of 21 patients with upper thoracic tuberculosis underwent the subscapularis transthoracic,debridement,bony fusion and internal fixation. Results The operation time was ranged 152 -238（ 192 ± 10） min. The blood loss was ranged 600 - 1 800（ 1 150 ± 235） ml. The follow-up time was 6 - 48 months. 2 cases were complicated with shoulder joint dysfunction after rehabilitation treatment,and returned to normal shoulder joint activity after follow-up about 6 months. 2 cases were complicated with lung infection. It had been cured after 10 days by anti-infection therapy. At last follow-up,there were 17 patients with spinal cord injury,Frankel scale improved by 1 case,16 cases of nerve function were recovered to normal. The kyphosis Cobb angles were 19° - 30°（ 24. 8° ± 5. 6°） after operation,with an average correction rate of 30. 9%. Conclusions Posterior debridement,bony graft and instrumentation is reliable and safe for upper thoracic tuberculosis underwent the subscapularis transthoracic,which has higher clinical value.

关 键 词：上胸椎结核 肩胛骨下胸腔入路 病灶清除 椎体间植骨 内固定 

分 类 号：R529.2[医药卫生—内科学] R687.3[医药卫生—临床医学]