Yu Fang-Yuan, Ma Yuan-Zheng, Li Hong-Wei, Chen Xing
Department of Orthopaedics, 309th Hospital of PLA, Beijing 100091, China.
Zhongguo Gu Shang. 2010 Jul;23(7):488-90.
To explore the surgical measurements and principles in the treatment of thoracic and thoracolumbar spinal tuberculosis.
From 2001 to 2008, 232 cases of thoracic or thoracolumbar spinal tuberculosis were treated by operations in the study, including 148 males and 84 females with an average age of 37.8 years ranging from 20 to 76 years. Preoperative assessment displayed as follow: Cobb angles of kyphosis < 30 degrees in 65 cases, 30 degrees to 60 degrees in 147 cases, > 60 degrees in 20 cases; Frankel B grade in 13 cases, C in 12 cases, D in 41 cases, E in 166 cases. Among them, 48 cases were performed with one-stage transpedicular screw system and anterolateral debridement by single incision, 184 cases with one-stage anterior approach (debridement, fusion, and plate-screw fixation) routinely. The tissues and liquor puris debrided from focus were sent for pathological examination, Bacillus tuberculosis detection and culture, and drug sensitivity test. The patients were given anti-tuberculosis therapy according the results of drug sensitivity test for 1 to 1.5 years. The followed-up included relapse rate, fusion of the bone graft, the status of neurological restoring, kyphosis correction etc.
All 232 cases recovered from perioperation and 230 cases got primary wound healing, only 2 cases performed with single incision one-stage posterior instrumentation and anterolateral debridement got complications of wound healing problems and the sinus formation,which delayed healed by changing dressings. The complications included intercostals neuralgia in 135 cases and pneumothorax or hydrothorax in 13 cases, which needed not special handling. All the patients in this series got the followed-up ranging from 1.0 to 4.5 years (means 2.6 years). No recurrence within followed-up period and bone union was found in all cases. All 66 cases with the neurological deficits recovered partially or totally. Kyphosis correction were achieved by 27.5 degrees on average postoperatively and showed a mild loss of 4.2 degrees on average during followed-up period. All cases were confirmed with Bacillus tuberculosis infection by pathology. Bacillus tuberculosis was detected and culture successfully in 107 cases (46.1%), 40 strains (37.4%) were drug resistant and in which 8 strains (7.5%) were multi-drug resistant.
For the treatment of thoracic and thoracolumbar spinal tuberculosis, the best treatment include directional chemotherapy, one-stage anterior approach with thorough debridement, auto-rib or Ti-mesh fusion, and plate-screw fixation.
探讨胸段及胸腰段脊柱结核的手术测量方法及治疗原则。
2001年至2008年，本研究对232例胸段或胸腰段脊柱结核患者行手术治疗，其中男性148例，女性84例，平均年龄37.8岁，年龄范围20至76岁。术前评估结果如下：后凸Cobb角<30°者65例，30°至60°者147例，>60°者20例；Frankel B级13例，C级12例，D级41例，E级166例。其中，48例行单切口一期经椎弓根螺钉系统联合前路清创术，184例行一期前路手术（清创、融合及钢板螺钉固定）。将病灶清除的组织及脓液送病理检查、结核杆菌检测及培养、药敏试验。根据药敏试验结果给予患者抗结核治疗1至1.5年。随访内容包括复发率、植骨融合情况、神经功能恢复状况、后凸矫正等。
232例患者围手术期均康复，230例切口一期愈合，仅2例行单切口一期后路内固定联合前路清创术的患者出现伤口愈合问题及窦道形成并发症，经换药后延迟愈合。并发症包括肋间神经痛135例，气胸或胸腔积液13例，均无需特殊处理。本系列所有患者均获随访，随访时间1.0至4.5年（平均2.6年）。随访期间无复发，所有病例均获骨融合。66例神经功能缺损患者均部分或完全恢复。术后平均后凸矫正27.5°，随访期间平均丢失4.2°。所有病例经病理证实有结核杆菌感染。107例（46.1%）结核杆菌检测及培养成功，40株（37.4%）耐药，其中8株（7.5%）耐多药。
对于胸段及胸腰段脊柱结核的治疗，最佳治疗方案包括定向化疗、一期前路彻底清创、自体肋骨或钛网融合及钢板螺钉固定。
