Cui Xu, Li Li-Tao, Ma Yuan-Zheng
Department of Orthopaedics, The 309th Hospital of the PLA, Beijing, China.
Orthop Surg. 2016 Nov;8(4):454-461. doi: 10.1111/os.12288.
To evaluate the clinical outcomes of anterior and posterior instrumentation with different debridement and graft fusion methods for multi-level contiguous thoracic spinal tuberculosis.
We retrospectively evaluated 81 patients with multi-level contiguous thoracic spinal tuberculosis who underwent anterior or posterior instrumentation combined with different methods of debridement, decompression, and graft fusion from January 2002 to December 2012. All patients were divided into an anterior instrumentation group and a posterior instrumentation group. In the anterior instrumentation group, there were 39 patients who underwent transthoracic debridement. In the posterior instrumentation group, there were 34 patients who underwent trans-costotransverse decompression and strut grafting with posterior instrumentation, and another 8 patients underwent combined anterior debridement and strut grafting with posterior instrumentation in a single-stage or two-stage procedure. The kyphotic angles were calculated from lateral spinal X-rays using the modified Konstam method. The symptoms and signs of tuberculosis, fusion level, fusion time of the bone graft, average kyphosis angle, average correction, average loss of correction, and clinical complications were recorded. The average follow-up period was 37 months (range, 17-72 months).
The cohort consisted of 47 males and 34 females with an average age of 38 years. The mean durations of the operations were 3.5 ± 0.4 h in the anterior group and 4.0 ± 0.3 h in the posterior group ( P < 0.05). The mean blood loss volumes during surgery were 450 ± 42 and 560 ± 51 mL for the anterior group and the posterior group, respectively ( P < 0.01). The kyphotic deformities were corrected from 32.1° ± 10.3° to 10.2° ± 2.1° in the anterior group and from 33.8° ± 11.7° to 12.6° ± 2.7° in the posterior group ( P < 0.01). The neurologic statuses of the 23 patients with preoperative neurologic deficits improved in each group. Fusion was confirmed radiographically at 5.4 ± 1.2 months (range, 4-12 months) in the anterior group and 5.6 ± 1.4 months (range, 4-13 months) in the posterior group ( P > 0.05). Postoperative relapses were noted in 1 and 3 patients in the anterior and the posterior group, respectively.
Posterior instrumentation was more effective than anterior instrumentation in the correction of kyphosis and the maintenance of the correction. However, postoperative sinus formation was more frequent in patients who underwent a single-stage posterior procedure.
评估前路和后路内固定结合不同清创及植骨融合方法治疗多节段连续性胸椎结核的临床疗效。
回顾性分析2002年1月至2012年12月期间接受前路或后路内固定并结合不同清创、减压及植骨融合方法的81例多节段连续性胸椎结核患者。所有患者分为前路内固定组和后路内固定组。前路内固定组39例患者接受经胸清创术。后路内固定组34例患者接受经肋横突减压及后路内固定支撑植骨，另有8例患者在一期或二期手术中接受前路清创联合后路支撑植骨。采用改良Konstam法从脊柱侧位X线片计算后凸角。记录结核的症状和体征、融合节段、植骨融合时间、平均后凸角、平均矫正度、平均矫正丢失及临床并发症。平均随访时间为37个月（范围17 - 72个月）。
该队列包括47例男性和34例女性，平均年龄38岁。前路组手术平均时长为3.5±0.4小时，后路组为4.0±0.3小时（P<0.05）。前路组和后路组手术中平均失血量分别为450±42毫升和560±51毫升（P<0.01）。前路组后凸畸形从32.1°±10.3°矫正至10.2°±2.1°，后路组从33.8°±11.7°矫正至12.6°±2.7°（P<0.01）。每组中23例术前有神经功能缺损的患者神经功能均有改善。前路组在5.4±1.2个月（范围4 - 12个月）经影像学证实融合，后路组在5.6±1.4个月（范围4 - 13个月）经影像学证实融合（P>0.05）。前路组和后路组分别有1例和3例患者术后复发。
后路内固定在矫正后凸及维持矫正方面比前路内固定更有效。然而，一期后路手术患者术后窦道形成更常见。
