一期后路病灶清除、椎间植骨融合内固定术治疗上胸椎结核  

One-stage posterior debridement, interbody fusion, and instrumentation for upper thoracic spinal tuberculosis

作　　者：徐震超 陈刚 曾凯斌 张治国 俞海亮 韩莹松 XU Zhenchao;CHEN Gang;ZENG Kaibin;ZHANG Zhiguo;YU Hailiang;HAN Yingsong(Department of Spine Surgery,Xiangtan Central Hospital,Xiangtan Hunan 411100,China)

机构地区：[1]湘潭市中心医院脊柱外科

出　　处：《临床与病理杂志》2019年第5期1040-1048,共9页Journal of Clinical and Pathological Research

基　　金：湘潭市科技计划项目(SF-YB20181007)~~

摘　　要：目的:探讨一期后路病灶清除、椎间植骨融合内固定治疗上胸椎结核的可行性及临床疗效。方法:回顾性研究2011年7月至2015年7月湘潭市中心医院脊柱外科收治的20例上胸椎(T1~4)脊柱结核患者。其中男13例,女7例;年龄24~72(51.7±14.0)岁。术前病变节段后凸Cobb角为31°~53°(46.7°±8.4°)。术前美国脊柱损伤协会(American Spinal Injury Association,ASIA)神经功能分级:B级2例,C级9例,D级8例,E级1例。均采用一期后路病灶清除、椎间植骨融合内固定术治疗。结果:所有患者术后随访36~60(46.7±8.4)个月,术后无严重并发症发生。术后后凸Cobb角为15°~25°(20.4°±3.0°),末次随访为16°~26°(21.3°±3.0°),较术前显著改善(P<0.05)。有神经功能障碍者术后均得到不同程度恢复,至末次随访,根据ASIA分级,2例由B级至D级,4例由C级至D级,5例由C级至E级,8例由D级至E级。视觉模拟评分(VisualAnalogueScale,VAS)均较术前得到明显改善(P<0.05)。所有患者在术后9~15(11.7±1.9)个月达到植骨融合,无内固定松动、断裂及假关节形成。结论:对于有手术适应证的上胸椎脊柱结核患者,应用一期后路病灶清除、椎间植骨融合内固定术治疗方法安全有效,且创伤小、并发症少,临床疗效满意。Objective:To investigate the feasibility and the clinical efficacy of treatment for upper thoracic spinal tuberculosis by one-stage posterior debridement,interbody fusion,and instrumentation.Methods:From July 2011 to July 2015,a total of 20 patiens suffering from upper thoracic spinal tuberculosis were collected.There were 13 males and 7 females,with age ranging from 24 to 72 (51.7±14.0) years old.The kyphotic Cobb angle of segmental spinal lesions pre-operation were 31°-53°(46.7°±8.4°).The neurological examination according to American Spinal Injury Association (ASIA) showed grade B in 2 cases,grade C in 9 cases,grade D in 8 cases,and grade E in 1 case.All the patients were treated with one-stage posterior debridement,interbody fusion,and instrumentation. Results:All patients were followed for 36-60 (46.7±8.4) months post-operation.No severe complications occurred.The kyphotic Cobb angle were 15°-25°(20.4°±3.0°) after the surgery,and at final follow-up were 16°-26°(21.3°±3.0°),which both was significantly decreased form the pre-operation (P<0.05).At the last follow-up visit,neurological status of the patients with preoperative neurological deficit according to ASIA:2 cases in grade B recovered to grade D,4 cases in grade C recovered to grade D,5 cases in grade C recovered to grade E,8 cases in grade D recovered to grade E.Visual Analogue Scale (VAS) pain score were significantly improved at the end of follow-up (P<0.05).Bone fusion occurred in all patients at 9-15 (11.7±1.9) months after the surgery.No fixation loose or breakage,and no pseudo articulation formation.Conclusion:One-stage posterior debridement,interbody fusion,and instrumentation can be an effective and feasible treatment option for upper thoracic spinal tuberculosis offering less trauma,and complications,the clinical effect was satisfied.

关 键 词：上胸椎结核 一期后路 植骨融合 

分 类 号：R687.3[医药卫生—骨科学]