胸椎结核不同术式的选择及其临床疗效的研究  

Selection of Different Surgical Methods for Thoracic Vertebrae Tuberculosis and Their Clinical Efficacy

作　　者：张映波[1] 谢海洋[1] 陈果[1] 付能高[1] 何江涛[1] 蔚芃[1] 蒋成[1] 

机构地区：[1]川北医学院附属医院骨科,四川南充637000

出　　处：《四川医学》2016年第3期248-251,共4页Sichuan Medical Journal

基　　金：四川省教育厅项目(编号:14ZB0199)

摘　　要：目的探讨胸椎结核不同术式的选择及其临床疗效的研究。方法我院于2008年1月至2015年1月采用不同手术方法治疗成人胸椎结核患者128例,合并有脊髓功能障碍9例,Franke1分级C级2例,D级7例。病变1个椎体22例,连续累及2个椎体84例,3个椎体18例,4个椎体3例,5个椎体1例,影像学提示均伴有不同程度的椎旁脓肿及死骨形成,脊柱后凸畸形Cobb角18°~53°。血沉及CRP升高,术前均正规抗结核治疗3~6周,根据病变部位、侵犯椎体数目及程度采用3种手术方式：A组经胸椎前路病灶清除、植骨融合、内固定术,52例;B组经胸椎后入路病灶清除、植骨融合、椎弓根螺钉内固定术,36例。C组经胸椎后入路椎弓根螺钉内固定式＋经胸椎前入路病灶清除植骨融合术,40例。术后继续抗结核治疗12~18个月,定期复查,对各组的治疗效果进行随访研究。结果所有患者均无手术相关严重并发症发生,A组手术时间和术中出血量平均为192min,390m L,B组分别为228min、440m L,C组分别为276min、550m L。A组胸椎后凸畸形Cobb角由术前平均（23.6±7.8）°矫正为（13.4±3.2）°,矫正率为（43.2±10.6）%;B组Cobb角由术前平均（26.8±8.2）°矫正为（9.1±2.4）°,矫正率为（66.1±14.2）%;C组Cobb角由术前平均（27.2±7.6）°矫正为（8.9±2.7）°,矫正率为（67.3±15.4）%。合并有脊髓功能障碍患者末次随访时,均有不同程度改善。B组和C组各有1例术后切口窦道形成,A组有1例术后8个月随访时发现内固定断裂,但病椎植骨已融合。结论在胸椎结核手术方式的选择方面,不同手术方式都能很好地完成对胸椎结核病灶的清除、脊髓减压、融合、固定以及矫正脊柱后凸畸形的作用,胸椎后路固定在脊柱后凸畸形矫形方面优于前路固定,但前路在病灶清除彻底程度方面优于后路,特别是超过2个椎体以上节段的病灶。Objective To investigate the choice of different surgical methods for thoracic vertebrae tuberculosis and research of their clinical efficacy. Methods From January 2015 to January 2008,our hospital used different surgical methods in the treatment of 128 cases of adult thoracic vertebrae tuberculosis,including 9 cases combined with spinal cord dysfunction,2 cases of Frankel C grade and 7 cases of Frankel D grade. 22 cases with lesions only involving a vertebral body,84 cases with lesions continuously involving two vertebral bodies,18 cases with lesions involving three vertebral bodies,3 cases with lesions involving four vertebral bodies and 1 case with lesion involving five vertebral bodies. Among these cases,imaging indicated that they were all companied by different degrees of paravertebral abscess and sequestrum formation,Cobb angles of spinal kyphosis arranged from 18° to56°and ESR as well as CRP increased. Patients all received preoperative antituberculosis therapy for 3-6 weeks. Three different kinds of surgical methods were adopted according to the lesion site,the number and extent of involved vertebral body： Group A included 52 cases of focus clearance,bone graft fusion and internal fixation through anterior thoracic spine approach; Group B included 36 cases of focus clearance,bone graft fusion and pedicle screw internal fixation through poterior thoracic spine approach;Group C included 40 cases of pedicle screw internal fixation through posterior thoracic spine approach and focus clearance and bone graft fusion through anterior thoracic spine approach. After the operations,the patients continued to receive antituberculosis treatment for 12-18 months as well as periodic review and the curative effect was followed up regularly. Results All patients had no serious complications associated with surgery. Operation time and blood loss of Group A averaged 192 min and 390 ml,those of Group B were 228 min and 440 ml,respetively and those of Group C were 276 min and 550 ml,respectively. In Group A,Cobb angle of

关 键 词：胸椎结核 外科治疗 术式选择 

分 类 号：R687.3[医药卫生—骨科学]