Zheng Changkun, Li Peng, Kan Wusheng
Department of Orthopaedics, Pu Ai Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Eur J Pediatr Surg. 2014 Feb;24(1):83-7. doi: 10.1055/s-0033-1354584. Epub 2014 Jan 17.
The use of thoracoscopy for the treatment of spinal disorders has been applied mostly in adults. However, thoracoscopic decompression of spinal tuberculosis in children has probably been rarely documented.
To assess the efficacy of video-assisted thoracoscopic anterior surgery (VATS) combined with posterior instrumentation for children with spinal tuberculosis.
Total 15 consecutive children with spinal tuberculosis with VATS combined with posterior instrumentation were included.
Overall 15 cases of spinal tuberculosis were treated with the procedure of posterior internal fixation and anterior debridement by VATS combined with posterior instrumentation between January 2002 and December 2006.There were nine males and six females with an average age of 11.6 years (8-15 y). All patients were given appropriate chemotherapy for 4 to 12 weeks preoperatively and 12 to 15 months postoperatively. All patients were followed up with evaluation of the changes of kyphotic deformity noted.
All the cases were followed up over an average of 37.3 months (range, 12-48 mo).The wounds were healed without chronic infection or sinus formation. Four patients improved three grades, two patients improved two grades, and seven patients improved one grade. The average neurological recovery in the patients was 1.44 grades on the scale by Frankel et al. The average preoperative kyphosis was 37 degrees (range, 23-59 degrees) and the average postoperative kyphosis was 25 degrees (range, 18-35 degrees) at final follow-up. Also, minimal progression of kyphosis was seen at final follow-up with an average kyphosis of 28 degrees (range, 20-40 degrees); and average loss of correction of 3 degree was seen at final follow-up.
VATS combined with posterior instrumentation achieve satisfactory results for children with spinal tuberculosis.
胸腔镜在脊柱疾病治疗中的应用主要集中于成人。然而，儿童脊柱结核的胸腔镜减压治疗可能鲜有文献记载。
评估电视辅助胸腔镜前路手术（VATS）联合后路内固定治疗儿童脊柱结核的疗效。
纳入15例连续接受VATS联合后路内固定治疗的儿童脊柱结核患者。
2002年1月至2006年12月期间，共15例脊柱结核患者接受了后路内固定及VATS联合后路内固定的前路清创手术。其中男性9例，女性6例，平均年龄11.6岁（8 - 15岁）。所有患者术前接受4至12周、术后接受12至15个月的适当化疗。对所有患者进行随访，观察后凸畸形的变化。
所有病例平均随访37.3个月（范围12 - 48个月）。伤口愈合，无慢性感染或窦道形成。4例患者改善3级，2例患者改善2级，7例患者改善1级。患者神经功能平均恢复1.44级（Frankel等评分标准）。末次随访时，术前平均后凸角度为37度（范围23 - 59度），术后平均后凸角度为25度（范围18 - 35度）。此外，末次随访时后凸畸形进展最小，平均后凸角度为度（范围20 - 40度）；末次随访时平均矫正丢失3度。
VATS联合后路内固定治疗儿童脊柱结核取得了满意的效果。
