椎旁肌间隙入路经关节突病灶清除椎体间植骨融合治疗胸椎结核  

Clinical study of transfacet debridement combined with bone grafting and internal fixation in treatment of thoracic tuberculosis via thoracic paraspinal approach

作　　者：徐勇[1] 许浩[1] 李锋[1] 熊伟[1] 方忠[1] 廖晖[1] XU Yong;XU Hao;LI Feng;XIONG Wei;FANG Zhong;LIAO Hui(Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)

机构地区：[1]华中科技大学同济医学院附属同济医院骨外科,武汉430030

出　　处：《骨科》2017年第2期81-84,90,共5页ORTHOPAEDICS

基　　金：国家自然科学基金(81472133);卫生行业科研专项项目(201002018)

摘　　要：目的探讨椎旁肌间隙入路经关节突病灶清除、椎体间植骨融合内固定治疗胸椎结核的可行性及临床疗效。方法回顾性分析我院于2012年6月至2014年8月应用椎旁肌间隙入路经关节突病灶清除、椎体间植骨融合内固定治疗的单节段胸椎结核病人25例,其中男11例,女14例;年龄为21~63岁,平均为39.5岁。其中T_(4/5)4例,T_(5/6)1例,T_(7/8)3例,T_(8/9)4例,T_(9/10)5例,T_(10/11)3例,T_(11/12)5例。X线片显示病人均有不同程度的脊椎局部后凸畸形,CT及MRI显示所有病灶均有不同程度骨质破坏及脓肿形成。术前美国脊柱损伤协会(American Spinal Injury Association,ASIA)脊髓损伤功能分级:D级5例,E级20例。记录并评价病人手术时间、术中出血量、术后并发症、神经功能恢复情况及植骨融合情况。结果所有病人手术均顺利完成,手术无严重并发症发生,平均手术时间为210 min,平均失血量为900 ml。病人均获得随访,随访时间为12~30个月,平均为20个月。术后3个月内红细胞沉降率(erythrocyte sedimentation rate,ESR)及C反应蛋白(C-reactive protein,CRP)恢复至正常水平。末次随访时植骨融合良好,融合率100%。末次随访神经功能均得到改善。结论椎旁肌间隙入路经关节突病灶清除、椎体间植骨融合内固定治疗胸椎结核具有疗效确切、创伤小及并发症较少的优点,是治疗胸椎结核的有效方法。Objective To evaluate the clinical feasibility and efficacy of transfacet debridement combined with bone grafting and internal fixation in treatment of thoracic tuberculosis via paraspinal approach.Methods From June2012to August2014,25patients with monosegmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach.There were11males and14females with age ranging from21to63years(average,39.5).There were4patients in T4/5,1patient in T5/6,3patients in T7/8,4patients in T8/9,5patients in T9/10,3patients in T10/11,and5patients in T11/12.Patients had different degraded local kyphosis deformity shown on X?ray,and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation.For theclassification of American Spinal Injury Association(ASIA),there were5cases of grade D and20cases of gradeE.The operation time,blood loss,postoperative complications,the situation of neurological recovery and bonyfusion were recorded.Results The average operation time was210min.The average blood loss was900ml.There were no severe complications during and after operation.All patients were followed up for12?30monthswith the average time of20months.The ESR and CRP were normal at3rd month after operation.The rate of bone fusion was100%.The neurological function was improved in all patients.Conclusion Transfacet debridement combined with bone grafting and internal fixation via paraspinal approach was a safe and effective surgery in the treatment of thoracic tuberculosis,and it can achieve less surgery injury,convenient operation,reliable fixation.

关 键 词：胸椎 结核 脊柱 胸椎椎旁肌入路 经关节突入路 椎体间植骨融合内固定术 

分 类 号：R687.3[医药卫生—骨科学]