胸腔镜辅助小切口前路清创与重建治疗胸椎结核：至少 5 年随访。
Anterior debridement and reconstruction via thoracoscopy-assisted mini-open approach for the treatment of thoracic spinal tuberculosis: minimum 5-year follow-up.
机构信息
Department of Spine Surgery, Second Xiangya Hospital of Central South University, Changsha, 410011, China.
出版信息
Eur Spine J. 2012 Mar;21(3):463-9. doi: 10.1007/s00586-011-2038-5. Epub 2011 Oct 14.
INTRODUCTION
Video-assisted thoracoscopic surgery (VATS) has been developed for surgical treatment of thoracic spinal tuberculosis to overcome the problems associated with a formal thoracotomy. VATS, however, is technically demanding with a difficult learning curve.
MATERIALS AND METHODS
We conducted a retrospective long-term follow-up study of anterior debridement and reconstruction via a thoracoscopy-assisted mini-open approach for the surgical treatment of thoracic spinal tuberculosis. There were 50 patients collected with mean age 38.3 years with thoracic spinal tuberculosis.
RESULTS
The average operative time was 210 min (range 170-300 min), the average blood loss during operation was 550 ml (range 300-1,000 ml), and the mean chest drainage duration was 3.5 days (3-5 days). Complications occurred in 17 patients (34%). The mean follow-up was 6.5 years. There was statistically difference in VAS 3 months after surgery compared to preoperatively (P<0.001), as well as final follow-up compared to 3 months post-op (P<0.001). In patients with minor pulmonary impairment as measured by pulmonary function testing, 15 improved to normal and 5 had no change. In patients with moderate pulmonary impairment, 6 improved to normal and 2 improved to minor impairment at final follow-up. Neurological improvement of one to three grades had occurred in 26 patients by final follow-up. There was statistically difference in kyphotic angle 3 months after surgery compared to preoperatively (P<0.05), as well as final follow-up compared to 3 months post-op (P<0.001). The average correction rate of kyphotic angle was 38.7% and the loss of correction rate was 1.3% at final follow-up. No recurrent tuberculosis was found.
CONCLUSION
Thoracoscopy-assisted mini-open approach can provide a simple, safe, and practical treatment option with minimal invasiveness in cases of thoracic spinal tuberculosis. Successful clinical and radiographic outcomes can be achieved via anterior debridement and reconstruction at long-term follow-up.
介绍
为了解决开胸手术相关问题，胸腔镜辅助下微创手术（VATS）已被应用于胸段脊柱结核的外科治疗。然而，VATS 技术要求高，学习曲线陡峭。
材料和方法
我们对胸腔镜辅助小切口前路清创和重建术治疗胸段脊柱结核进行了回顾性长期随访研究。共纳入 50 例胸段脊柱结核患者，平均年龄 38.3 岁。
结果
平均手术时间为 210 分钟（170-300 分钟），术中平均出血量为 550 毫升（300-1000 毫升），平均胸腔引流时间为 3.5 天（3-5 天）。17 例（34%）患者出现并发症。平均随访时间为 6.5 年。术后 3 个月 VAS 与术前相比有统计学差异（P<0.001），与术后 3 个月相比也有统计学差异（P<0.001）。肺功能检查提示轻度肺功能损害的患者中，15 例恢复正常，5 例无变化。中度肺功能损害的患者中，6 例恢复正常，2 例在末次随访时改善为轻度损害。末次随访时，26 例患者的神经功能改善 1-3 级。术后 3 个月与术前相比，后凸角有统计学差异（P<0.05），末次随访与术后 3 个月相比也有统计学差异（P<0.001）。后凸角平均矫正率为 38.7%，末次随访时矫正丢失率为 1.3%。无结核复发。
结论
胸腔镜辅助小切口前路清创和重建术治疗胸段脊柱结核具有微创、安全、实用的特点。长期随访时，患者的临床和影像学结果良好。
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