Department of Spinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Orthop Surg. 2010 Nov;2(4):305-9. doi: 10.1111/j.1757-7861.2010.00104.x.
To study an anterior transsternal approach for treatment of upper thoracic vertebral (T(l)-T(4)) tuberculosis (TB).
Sixteen patients with upper thoracic vertebral TB underwent anterior decompression and fusion through an anterior transsternal approach. There were nine men and seven women with a mean age of 48.6 ± 2.3 years (range, 37 to 72 years). The involved area included T(l) in three patients, T(2) in one, T(2) and T(3) in four, T(3) in two, T(3) and T(4) in four, and T(4) in two. The "inside window of the brachiocephalic artery" was used to access T(1) and T(2) lesions, and the "outside window of the brachiocephalic artery" for T(3) and T(4) lesions, for T2 and T3, both "windows" were used. According to the Frankel grading system, two patients were of Grade A, one Grade B, two Grade C, six Grade D and five Grade E. The kyphosis Cobb's angle ranged from 15°-40° (mean, 22° ± 2.5°) preoperatively.
All patients tolerated surgery wel1. The operation time was 120-150 minutes and bleeding during operation 300-600 ml. The kyphosis Cobb's angle ranged from 10°-25° (mean, 17° ± 2.5°) postoperatively. Eight patients with preoperative neurologic deficit had improved. During the follow-up period, all cases healed without any recurrence. There was no failure of internal fixation. Spinal bone fusion occurred after 3-6 months (mean, 4.2 months) after bone graft in all patients.
The anterior transsternal approach provides safe and effective access for surgical treatment of upper thoracic TB.
研究经胸骨前入路治疗上胸椎（T1-T4）结核的方法。
16 例上胸椎结核患者行经胸骨前入路前路减压融合术。男 9 例，女 7 例；年龄 37-72 岁，平均 48.6±2.3 岁。病变累及 T1 3 例，T2 1 例，T2-3 4 例，T3 2 例，T3-4 4 例，T4 2 例。采用“锁骨下动脉内窗”入路处理 T1、T2 病变，“锁骨下动脉外窗”入路处理 T3、T4 病变，T2、T3 病变则采用两个“窗口”。术前神经功能按 Frankel 分级：A级 2 例，B 级 1 例，C 级 2 例，D 级 6 例，E 级 5 例。术前后凸 Cobb 角 15°-40°，平均 22°±2.5°。
16 例手术均顺利完成，手术时间 120-150min，出血量 300-600ml。术后后凸 Cobb 角 10°-25°，平均 17°±2.5°。术前有神经功能障碍的 8 例患者均有不同程度改善。随访期间所有患者均获骨性愈合，无结核复发，无内固定失败。术后 3-6 个月（平均 4.2 个月）植骨均获骨性融合。
经胸骨前入路可安全有效地治疗上胸椎结核。
