Li Zhaowei, Li Kunxiang, Tang Baoming, Ren Rong, Zhang Yuan, Li Zeqing, Wang Zengdong, Zhang Xuebin
Department of Orthopedics Trauma, Qinghai University Affiliated Hospital, Xining.
Department of Orthopedics Trauma, Haidong People's Hospital of Qinghai Province, Haidong.
J Craniofac Surg. 2020 Mar/Apr;31(2):480-483. doi: 10.1097/SCS.0000000000006097.
The purpose of this study was to explore the clinical effect of the anterior approach to the lower cervical spine for cervicothoracic spinal tuberculosis (CTSTB).
A total of 8 patients (6 males and 2 females) with CTSTB diagnosed by imaging examination and γ-interferon test, underwent the first stage lesion removal, bone grafting and internal fixation through the anterior approach to the lower cervical spine, were studied. Then, the clinical efficacy was evaluated using statistical analysis based on the materials about the Cobb angle of kyphosis, visual analog scale (VAS), Frankel grade, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).
All patients' age ranged from 28 to 64 years (mean 46.2 ± 16.3). The mean operation time was 145 minutes (range 90-180 mins), intraoperative blood loss was 425 mL (range 200-1000 mL), and the average bone fusion time was 7.4 months. Postoperative neurological function of Frankel grading was significantly improved compared with that of preoperative. At final follow-up, the kyphosis angle was significantly decreased to 10 ± 2.1°, the mean VAS score was 1.6 ± 0.9 showing significant improvement, ESR and CRP returned to normal. The incidence of complications within 3 months after surgery was 25%, and the incidence of complications directly related to surgery was 12.5% (cerebrospinal fluid leakage).
On the basis of familiarity with the anatomical structure and combining with the experience of the surgeon, the anterior approach to the lower cervical spine can be an effective treatment method for CTSTB.
本研究旨在探讨下颈椎前路手术治疗颈胸段脊柱结核（CTSTB）的临床效果。
选取8例经影像学检查及γ-干扰素检测确诊为CTSTB的患者（6例男性，2例女性），采用下颈椎前路一期病灶清除、植骨融合内固定术，并根据后凸Cobb角、视觉模拟评分（VAS）、Frankel分级、血沉（ESR）及C反应蛋白（CRP）等资料进行统计学分析，评估临床疗效。
所有患者年龄在２８～６４岁之间（平均4６.2±16.3岁）。平均手术时间为145分钟（90～180分钟），术中出血量为425ｍｌ（200～1000ｍｌ），平均植骨融合时间为7.4个月。术后Frankel神经功能分级较术前明显改善。末次随访时，后凸角明显减小至10±2.1°，平均VAS评分为1.6±0.9，改善明显，ESR及CRP恢复正常。术后３个月内并发症发生率为25％，与手术直接相关的并发症发生率为12.5％（脑脊液漏）。
在熟悉解剖结构的基础上，结合术者经验，下颈椎前路手术可作为治疗CTSTB的有效方法。
