Srivastava Sudhir Kumar, Aggarwal Rishi Anil, Bhosale Sunil Krishna, Roy Kunal, Nemade Pradip Sharad
Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Maharashtra, India.
Asian Spine J. 2017 Apr;11(2):294-304. doi: 10.4184/asj.2017.11.2.294. Epub 2017 Apr 12.
Retrospective case series.
To describe a novel single incision that combines anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine and study the neurological and radiological outcomes.
Tuberculosis of the spine remains a major health issue in many developing countries. The options for treating tuberculosis of the thoracic spine include the anterior, posterior, and combined approaches, each with its advantages and disadvantages.
Totally, 143 patients with tuberculosis of the thoracic spine were surgically treated using the "Versatile approach". Posterior fixation was performed using sublaminar wires and a Hartshill rectangle in all patients. Anterior reconstruction was accomplished using bone graft harvested from autologous rib, iliac crest, or fibula.
The study included 45 males and 98 females, with a mean age of 33.18±18.65 years (range, 3-82 years) and a mean follow-up of 60.23±24.56 months (range, 18-156 months). Kyphosis improved from a mean value of 24.02 preoperatively to 10.25 postoperatively. A preoperative neurological deficit was observed in 131 patients, with 130 patients regaining ambulatory power. No patient had deterioration of neurological status following surgery. Fusion was achieved in all cases. The visual analogscale score improved from an average score of 7.02 preoperatively to 1.51 at final follow-up. Eight patients had superficial macerations, which healed spontaneously. One patient had buckling of the anterior graft, and one patient had implant breakage following road traffic accident.
The "Versatile approach" is an effective, single-stage, single-incision method that combines anterior and posterior approaches for the surgically treating tuberculosis of the thoracic spine. It offers the advantage of direct visualization for decompression and reconstruction of the anterior and posterior vertebral columns, thus providing an excellent, long-lasting clinical outcome.
回顾性病例系列研究。
描述一种结合前后路入路进行减压和器械融合治疗胸椎结核的新型单切口手术方法，并研究其神经功能和影像学结果。
脊柱结核在许多发展中国家仍然是一个主要的健康问题。治疗胸椎结核的方法包括前路、后路和联合入路，每种方法都有其优缺点。
共有143例胸椎结核患者采用“多功能入路”进行手术治疗。所有患者均采用椎板下钢丝和哈氏棒进行后路固定。前路重建采用取自自体肋骨、髂嵴或腓骨的骨移植材料。
该研究纳入45例男性和98例女性，平均年龄33.18±18.65岁（范围3 - 82岁），平均随访时间60.23±24.56个月（范围18 - 156个月）。后凸畸形从术前的平均24.02改善至术后的10.25。131例患者术前存在神经功能缺损，其中130例患者恢复了行走能力。术后无患者神经功能状态恶化。所有病例均实现融合。视觉模拟评分从术前的平均7.02分改善至末次随访时的1.51分。8例患者出现浅表皮肤浸渍，均自行愈合。1例患者前路植骨块弯曲，1例患者在交通事故后出现内植物断裂。
“多功能入路”是一种有效、单阶段、单切口的方法，结合了前后路入路用于手术治疗胸椎结核。它具有直接可视化减压和重建前后脊柱柱的优势，从而提供了良好的、持久的临床效果。
