上胸椎结核后路病灶清除融合固定术  

Posterior debridement and instrumented fusion for upper thoracic spinal tuberculosis

作　　者：张涛 刘华 李松凯 ZHANG Tao;LIU Hua;LI Song-kai(Department of Spinal Surgery,940 th Hospital,Joint Logistic Support Force of PLA,Lanzhou730050,China)

机构地区：[1]联勤保障部队第九四〇医院脊柱外科,甘肃兰州730050

出　　处：《中国矫形外科杂志》2023年第17期1609-1612,共4页Orthopedic Journal of China

基　　金：甘肃省重点研发计划项目(编号:21YF1FA179);甘肃省卫生健康行业科研项目(编号:GSWSKY2020-05);军队医学科技青年培育计划项目(编号:20QNPY071)。

摘　　要：[目的]介绍一期后路病灶清除植骨融合内固定治疗上胸椎结核的手术技术及初步临床疗效。[方法]8例上胸椎结核患者接受上述手术治疗。后正中切口显露至双侧肋横突关节及肋骨,切除椎体破坏较严重一侧横突、肋骨及肋横突关节,充分显露病椎、引流椎旁脓肿,刮匙彻底清除死骨及肉芽组织。置入椎弓钉,椎管减压后矫正后凸畸形,取自体髂骨、肋骨或填充自体骨的钛笼重建椎体间骨缺损。[结果]8例患者均顺利完成手术,手术时间平均(262.5±43.3)min,术中出血量平均(625.0±333.8)ml,术后引流量平均(285.0±118.1)ml。与术前相比,末次随访时VAS评分[(4.8±0.9),(0.6±0.7),P<0.001]、ODI评分[(43.3±14.7)%,(7.6±5.6)%,P<0.001],ESR[(39.1±13.5)mm/h,(9.8±5.4)mm/h,P<0.001]、CRP[(25.0±14.3)mg/L,(4.7±2.6)mg/L,P<0.001]均显著改善。患者神经功能显著改善,后凸矫形率达(71.5±7.3)%。[结论]单纯一期后路病灶清除植骨融合内固定术治疗上胸椎操作相对简单、创伤较小,疗效可靠。[Objective]To introduce the surgical technique and preliminary clinical outcomes of one-stage posterior debridement and instrumented fusion for upper thoracic tuberculosis.[Methods]A total of 8 patients received abovesaid surgical treatment for upper thoracic spinal tuberculosis.A posterior midline incision was made to expose the deep structure extended to costotransverse joint and ribs bilaterally.After the transverse process,ribs,and costotransverse joint on the side with severe vertebral destruction were removed,the affected vertebra was fully exposed and the paravertebral abscess was drained.The pedicle screws and rods were installed,the spinal decompression was finished with correction of the kyphosis,and the intervertebral bone defect was reconstructed by titanium cage with bone autograft harvested from the iliac crest.[Results]All the 8 patients were successfully operated on with the operation time of(262.5±43.3)min,intraoperative blood loss of(625.0±333.8)ml,and postoperative drainage of(285.0±118.1)ml.Compared with those preoperatively,the VAS scores[(4.8±0.9),(0.6±0.7),P<0.001],ODI score[(43.3±14.7)%,(7.6±5.6)%,P<0.001],ESR[(39.1±13.5)mm/h,(9.8±5.4)mm/h,P<0.001],CRP[(25.0±14.3)mg/L,(4.7±2.6)mg/L,P<0.001]were significantly improved at the latest follow-up.In addition,the patients got significant improvement in neurological function with kyphotic correction rate of(71.5±7.3)%at the latest follow-up.[Conclusion]The one-stage posterior debridement with instrumented fusion is relatively simple,less traumatic and effective technique for treatment of upper thoracic spinal tuberculosis.

关 键 词：上胸椎 脊柱结核 后路 病灶清除术 固定融合 

分 类 号：R529.2[医药卫生—内科学]