Zhang Hong-Qi, Hu Xiongke, Yin Xinhua, Chen Yong
Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya, China,
Int Orthop. 2015 Aug;39(8):1605-10. doi: 10.1007/s00264-015-2778-7. Epub 2015 Apr 26.
The purpose of this study was to investigate the clinical efficacy and feasibility of one-stage posterior fixation, anterior debridement, bone grafting and anterior fixation for multiple cervicothoracic spinal tuberculosis with kyphosis.
From December 2006 to June 2011, fifteen patients (seven males, eight females) suffering from cervicothoracic spinal tuberculosis with kyphosis were admitted. The pathologic change regions were as follows: two in the C6-C7 segment, two in the C6-T1 segment, one in the C6-T2 segment, three in the C7-T1 segment, two in the T1-T2 segment, two in the C7-T2 segment, one in the T1-T3 segment, and two in the T2-T3 segment. All patients were treated with one-stage surgical treatment by posterior fixation, anterior debridement, bone grafting, and anterior fixation. Then, the clinical efficacy was evaluated using statistical analysis based on the materials about the Cobb angle of kyphosis, Frankel grade and erythrocyte sedimentation rate (ESR), which were collected at certain times.
All patients ages ranged from 17 to 67 years (average, 40.9 years). Operation time ranged from 180 to 290 min (average, 226 minutes). Intra-operative blood loss ranged from 400 to 1000 ml (average, 650 ml). All patients were followed up for 18-46 months postoperatively (average, 27.7 months). The kyphosis angle was changed significantly between pre-operation and postoperation (P < 0.05), and there was no obvious loss at the last follow-up. The ESR recovered to normal within three months postoperatively in all patients (P < 0.05). Bone fusion was achieved within three to six months (average, 5.5 months). In the 15 cases, no postoperative severe complications occurred and neurologic function was improved in various degrees.
The outcomes of follow-up showed that the one-stage combined anterior-posterior approach can be an effective treatment method for multiple cervicothoracic spinal tuberculosis with kyphosis.
本研究旨在探讨一期后路固定、前路清创、植骨融合及前路固定治疗多节段颈胸段脊柱结核伴后凸畸形的临床疗效及可行性。
2006年12月至2011年6月，收治15例颈胸段脊柱结核伴后凸畸形患者（男7例，女8例）。病变节段分布如下：C6-C7节段2例，C6-T1节段2例，C6-T2节段1例，C7-T1节段3例，T1-T2节段2例，C7-T2节段2例，T1-T3节段1例，T2-T3节段2例。所有患者均接受一期后路固定、前路清创、植骨融合及前路固定手术治疗。然后，根据特定时间收集的关于后凸畸形Cobb角、Frankel分级及红细胞沉降率（ESR）的资料，采用统计学分析评估临床疗效。
所有患者年龄在17至67岁之间（平均40.9岁）。手术时间为180至290分钟（平均226分钟）。术中出血量为400至1000毫升（平均650毫升）。所有患者术后随访18至46个月（平均27.7个月）。术前与术后后凸角变化显著（P < 0.05），末次随访时无明显丢失。所有患者术后3个月内ESR恢复正常（P < 0.05）。3至6个月内实现骨融合（平均5.5个月）。15例患者术后均未发生严重并发症，神经功能均有不同程度改善。
随访结果表明，一期前后联合入路是治疗多节段颈胸段脊柱结核伴后凸畸形的有效方法。
