Feng Meng-Ming, Hu Ming, Ma Yuan-Zheng, Xue Hai-Bin, Li Da-Wei
Department of Orthopaedics, the 309th Hospital of PLA, Beijing 100091 ,China.
Zhongguo Gu Shang. 2011 Apr;24(4):323-6.
To explore the long-term effects,operating opportunity,indication of anterior debridement and decompression and bone graft in treating thoracolumbar tuberculosis with paraplegia.
From March 2006 to September 2008, the data of 56 patients with spinal tuberculosis were retrospectively analyzed. They were 36 cases male and 20 cases female, the age in ranging from 19 to 78 years with the mean of 42.5 years; course of disease in ranging from 3 months to 4 years. The lesion level was in T11-L2, including one stage in 6 cases, two stages in 42 cases, three stages in 7 cases, four stages in 1 case. According to the Frankel grade, grade A in 5 cases, B in 25, C in 21, D in 5. Preoperative Cobb angle had 30 cases under 30 degrees, 24 cases in 30 degrees-60 degrees, 2 cases more than 60 degrees [averaged in (35.0 +/- 3.3) degrees]. The mean VAS was 7.3 +/- 2.1 preoperatively. All patients had chemotherapy for 2-3 weeks. The clinical effects were evaluated by Cobb angle, VAS, condition of Frankel grade and fusion segments.
All patients were followed up from 12 to 38 months with an average of 24 months. All wound obtained primary healing. The Cobb angle was(19.0 +/- 5.5) degrees immediately after operation, and lost (1.8 +/- 0.7) degrees at the follow up. The mean VAS was 1.4 +/- 0.3 postoperatively and 1.3 +/- 0.4 at final follow up. The Cobb angle and VAS significant improved in postoperatively (P < 0.05), and there was no statically difference between after operation and last follow up(P > 0.05). At 1 year after operation, all patients obstained successful bony fusion. Among 51 cases incomplete paraplegia recovered partially or completely (over Frankel D) through chemotherapy and rehabilitation training for 1-1.5 years; 5 cases of complete paraplegia had partially recovered, 3 cases from Frankel A to C, 2 cases from Frankel A to B.
Base on the chemotherapeutic effect, paraplegia reason and location, total body condition to select different operative opportunity can effectively relieve spinal compression, stabilize spinal column, correct kyphosis and promote recovery of paraplegia.
探讨前路病灶清除减压植骨术治疗胸腰椎结核并截瘫的远期疗效、手术时机及适应证。
回顾性分析2006年3月至2008年9月收治的56例脊柱结核患者资料。男36例，女20例；年龄19～78岁，平均42.5岁；病程3个月至4年。病变节段为T11-L2，其中Ⅰ期6例，Ⅱ期42例，Ⅲ期7例，Ⅳ期1例。按Frankel分级：A级5例，B级25例，C级21例，D级5例。术前Cobb角＜30°30例，30°～60°24例，＞60°2例，平均(35.0±3.3)°。术前VAS平均7.3±2.1。所有患者均先行2～3周化疗。通过Cobb角、VAS、Frankel分级情况及融合节段评价临床疗效。
所有患者随访12～38个月，平均24个月。所有伤口均一期愈合。术后即刻Cobb角(19.0±5.5)°，随访时丢失(1.8±0.7)°。术后VAS平均1.4±0.3，末次随访时1.3±0.4。术后Cobb角及VAS较术前明显改善(P＜0.05)，术后与末次随访比较差异无统计学意义(P＞0.05)。术后1年所有患者均获骨性融合成功。51例不全瘫患者经1～1.5年化疗及康复训练部分或完全恢复(Frankel D级以上)；5例完全瘫患者部分恢复，3例由Frankel A级恢复至C级，2例由Frankel A级恢复至B级。
根据化疗效果、截瘫原因及部位、全身状况选择不同的手术时机，能有效解除脊髓压迫，稳定脊柱，矫正后凸畸形，促进截瘫恢复。
