Srivastava Sudhir Kumar, Marathe Nandan A, Bhosale Sunil K, Raj Aditya, Purohit Shaligram, Shaikh Ashraf, Dhole Kiran
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Indian Spinal Injuries Centre, New Delhi, India.
Asian J Neurosurg. 2020 Aug 28;15(3):648-652. doi: 10.4103/ajns.AJNS_52_20. eCollection 2020 Jul-Sep.
Tricortical iliac bone is the gold standard as an autograft for the reconstruction of the anterior column in tuberculosis (TB) of the thoracic spine. However, the quantity of graft needed is significant. It creates a considerable defect in the pelvic bone, causing graft site complications, including pain, pelvic instability, fractured ilium, herniated muscle, or abdominal contents. To prevent these donor site morbidities, ribs that were removed during the versatile approach were used for anterior reconstruction. The aim of this study was to assess the clinical and radiological results of the reconstruction of the anterior column of the spine with the help of an excised rib during the versatile approach.
This retrospective study was undertaken at a tertiary care center with a study duration of 14 years. Between January 2004 and December 2016, 52 patients with thoracic Koch's spine had anterior column reconstructed with multiple rib grafts. A single surgeon performed all operations. Indications for the surgery in these patients were the presence of neurologic deficit (49 patients) and vertebral column instability (3 patients). The preoperative kyphosis angle and visual analog scale (VAS) score were compared with postoperative values using a paired t-test.
All patients underwent a minimum follow-up of 18 months and were evaluated clinicoradiologically. Good bony fusion with neurological recovery was achieved in all cases. The VAS score for back pain improved significantly postsurgery. There was one case of graft buckling treated conservatively.
Appropriate anterior reconstruction forms the cornerstone of successful surgical management of spinal TB. The "Versatile approach" used offers anterior and posterior access in the lateral position. In these patients, we obviated the need for iliac crest graft using multiple segments of the rib for anterior column reconstruction. This meticulous rib grafting technique gives good functional outcome in terms of solid bony fusion.
Meticulous rib grafting technique gives 360° bony fusion and good functional outcome in surgery for thoracic spinal TB. It has the advantage of avoiding the complications associated with a tricortical iliac crest graft.
三皮质髂骨是胸椎结核前路重建自体骨移植的金标准。然而，所需移植骨的量很大。这会在骨盆骨上造成相当大的缺损，导致移植部位出现并发症，包括疼痛、骨盆不稳定、髂骨骨折、肌肉疝出或腹腔内容物疝出。为预防这些供区并发症，在采用多术式入路时切除的肋骨被用于前路重建。本研究的目的是评估在多术式入路过程中利用切除的肋骨重建脊柱前路的临床和影像学结果。
本回顾性研究在一家三级医疗中心进行，研究时长为14年。2004年1月至2016年12月期间，52例胸椎结核患者采用多根肋骨移植进行了前路重建。所有手术均由同一位外科医生完成。这些患者的手术指征为存在神经功能缺损（49例患者）和脊柱不稳定（3例患者）。术前后凸角和视觉模拟评分（VAS）与术后值采用配对t检验进行比较。
所有患者均接受了至少18个月的随访，并进行了临床和影像学评估。所有病例均实现了良好的骨融合且神经功能恢复。术后背痛的VAS评分显著改善。有1例移植骨弯曲的病例采用保守治疗。
合适的前路重建是脊柱结核手术成功治疗的基石。所采用的“多术式入路”可在侧卧位提供前路和后路入路。在这些患者中，我们通过使用多段肋骨进行前路重建，避免了髂嵴移植的需要。这种精细的肋骨移植技术在坚实的骨融合方面取得了良好的功能结果。
精细的肋骨移植技术在胸椎结核手术中可实现360°骨融合并取得良好的功能结果。它具有避免三皮质髂嵴移植相关并发症的优势。
