一期后路内固定、清创及后路椎间植骨融合术治疗胸上段脊柱结核
One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach.
机构信息
Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China.
出版信息
Eur Spine J. 2013 Mar;22(3):616-23. doi: 10.1007/s00586-012-2470-1. Epub 2012 Aug 18.
PURPOSE
To investigate the clinical efficacy and feasibility of one-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach.
METHODS
Fourteen patients (eight males, six females) with upper thoracic tuberculosis whose lesions were confined to two adjacent segments were admitted to our hospital. Their ages ranged from 23 to 72 years (average, 50 years). The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. ASIA classification showed that preoperatively, one patient was grade A, two patients were grade B, eight patients were grade C, and three patients were grade D. All patients were treated with one-stage surgical treatment by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach. Patients were evaluated preoperatively and postoperatively by measurement of thoracic kyphotic angles using Cobb angle evaluation, determination of erythrocyte sedimentation rate (ESR), evaluation of ASIA impairment scale, and radiological examination.
RESULTS
Operation time ranged from 70 to 135 min, (average, 110 min). Intraoperative blood loss ranged from 200 to 950 mL (average, 450 mL). All patients were followed up for 22 to 48 months postoperatively (average, 31.5 months). No sinus tract formation, cerebrospinal meningitis, or recurrence of tuberculosis occurred. All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 12°-26° postoperatively, and at final follow-up were 13°-28°. The ESR recovered to normal within 6 months postoperatively in all patients. Bone fusion was achieved within 3-8 months (average, 5.5 months).
CONCLUSIONS
One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method.
目的
探讨后路一期内固定、清创、前后路联合病灶清除植骨融合治疗上胸椎结核的临床疗效和可行性。
方法
回顾性分析 2010 年 1 月至 2016 年 1 月我院收治的 14 例上胸椎结核患者，病变均累及相邻 2 个节段，男 8 例，女 6 例；年龄 23～72 岁，平均 50 岁。采用美国脊髓损伤协会（ASIA）神经功能分级评估术前神经功能，A 级 1 例，B 级 2 例，C 级 8 例，D 级 3 例。所有患者均采用后路一期内固定、清创、前后路联合病灶清除植骨融合术治疗。比较患者术前、术后的后凸 Cobb 角、红细胞沉降率（ESR）、ASIA 分级及影像学检查，评估手术疗效。
结果
手术时间 70～135 min，平均 110 min；术中出血量 200～950 mL，平均 450 mL。术后随访 22～48 个月，平均 31.5 个月。无窦道形成、脑膜炎、结核复发等并发症。末次随访时 ASIA 分级均较术前明显改善，后凸 Cobb 角由术前的 12°～26°矫正至术后的 13°～28°，ESR 术后 6 个月内均恢复正常，植骨均于术后 3～8 个月融合，平均 5.5 个月。
结论
后路一期内固定、清创、前后路联合病灶清除植骨融合治疗上胸椎结核是一种有效、可行的方法。
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