上中胸段结核单纯后路病灶清除固定融合  

Debridement and instrumented fusion through a mere posterior approach for upper-middle-segment thoracic spine tuberculosis

作　　者：缪俊贤 詹乙 王江涛[2,3] 贺宝荣 郝定均[2] 王彪[2] MIAO Jun-xian;ZHAN Yi;WANG Jiang-tao;HE Bao-rong;HAO Ding-jun;WANG Bio(The Second Clinical College,Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712046,China;Honghui Hospital,Xi'an Jiaotong University,Xi'an,Shaanxi 710054,China;School of Medicine,Yan'an University,Yan'an,Shaanxi 716099,China)

机构地区：[1]陕西中医药大学第二临床医学院,陕西咸阳712046 [2]西安交通大学附属红会医院,陕西西安710054 [3]延安大学医学院,陕西延安716099

出　　处：《中国矫形外科杂志》2025年第2期180-184,共5页Orthopedic Journal of China

摘　　要：[目的]探讨上中胸段(T4~6)结核单纯后路病灶清除固定融合的临床效果。[方法]回顾性分析2011年1月—2016年1月在本院行上述手术治疗的67例T4~6节段结核患者的临床资料,评价临床及辅助检查结果。[结果]患者均顺利完成手术,手术时间平均(165.1±27.9)min;术中出血量平均(792.5±297.2)ml。67例患者均获得5年以上随访,与术前相比,术后1个月及末次随访时,VAS评分[(7.1±1.1),(1.7±0.2),(1.3±1.1),P<0.001]、ODI[(48.9±15.4),(20.2±1.7),(11.2±4.1),P<0.001]显著减少;与术前相比,末次随访时ASIA分级[例,B/C/D/E,(3/5/19/40),(0/2/3/62),P<0.001]显著改善。辅助检查方面,与术前相比,术后1个月及末次随访时,后凸Cobb角[(34.8±10.9)°,(10.2±1.3)°,(11.3±3.2)°,P<0.001]显著减小,ESR[(50.9±16.6)mm/h,(16.9±3.2)mm/h,(10.1±2.4)mm/h,P<0.001]和CRP[(34.1±16.7)mg/L,(9.2±2.5)mg/L,(2.6±2.0)mg/L,P<0.001]均显著降低。[结论]上中胸段结核单纯后路病灶清除固定融合术能有效清除病灶并纠正后凸畸形,对于T4~6节段结核有良好疗效。[Objective]To investigate the clinical consequence of debridement and instrumented fusion through a mere posterior ap-proach for upper-middle-segment thoracic spine(T4~6)tuberculosis.[Methods]A retrospective study was conducted on 67 patients whohad T4~6 tuberculosis treated surgically by abovesaid technique in our hospital from January 2011 to January 2016.The clinical and auxilia-ry examination data were evaluated.[Results]All patients had the surgical procedures performed successfully with the average operationtime of(165.1±27.9)min,and average intraoperative blood loss of(792.5±297.2)ml.All of them were followed up for more than 5 years.Astime elapsed from the point before operation,1 month postoperatively to the latest follow-up,the VAS score[(7.1±1.1),(1.7±0.2),(1.3±1.1),P<0.001],ODI[(48.9±15.4),(20.2±1.7),(11.2±4.1),P<0.001]significantly reduced.However,compared with that preoperatively,the ASIAneurological function grade significantly improved at the last follow-up[B/C/D/E,(3/5/19/40),(0/2/3/62),P<0.001].As for auxiliary exami-nation,the local kyphotic angle[(34.8±10.9)°,(10.2±1.3)°,(11.3±3.2)°,P<0.001],ESR[(50.9±16.6)mm/h,(16.9±3.2)mm/h,(10.1±2.4)mm/h,P<0.001]and CRP[(34.1±16.7)mg/L,(9.2±2.5)mg/L,(2.6±2.0)mg/L,P<0.001]were significantly decreased over time.[Conclu-sion]The debridement and instrumented fusion through a mere posterior approach do effectively remove the lesions and correct the kyphot-ic deformity,and achieve a satisfactory outcomes for T4~6 tuberculosis.

关 键 词：胸椎 脊柱结核 后入路 病灶清除 固定融合 

分 类 号：R529.2[医药卫生—内科学]