Ma Jibin, Zhang Zepei, Lan Jie, Tian Jiwei, Chen Fulin, Miao Jun
Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
Department of Orthopedics, The Second People's Hospital of Changzhi, Changzhi, China.
Front Surg. 2023 Sep 5;10:1236611. doi: 10.3389/fsurg.2023.1236611. eCollection 2023.
The complex anatomical structure of the upper thoracic spine makes it challenging to achieve surgical exposure, resulting in significant surgical risks and difficulties. Posterior surgery alone fails to adequately address and reconstruct upper thoracic lesions due to limited exposure. While the anterior approach offers advantages in fully exposing the anterior thoracic lesions, the surgical procedure itself is highly intricate. Although there exist various anterior approaches for the upper thoracic spine, the incidence of upper thoracic spine lesions is relatively low. Consequently, there are limited reports on the treatment and reconstruction of upper thoracic spine lesions using the third rib small incision approach in the context of upper thoracic tuberculosis.
We collected data from four patients with upper thoracic tuberculosis who were admitted to our department between July 2017 and November 2022. The treatment for upper thoracic tuberculosis involved utilizing the third rib small incision approach, which included two cases of thoracic 3-4 vertebral tuberculosis, one case of thoracic 4 vertebral tuberculosis, and one case of thoracic 5 vertebral tuberculosis. Among the patients, three were positioned in the left lateral position, while one was positioned in the right lateral position. Prior to admission, all four patients received a two-week course of oral medication, consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol. After the surgical procedure, they continued receiving anti-tuberculosis treatment for a duration of 12 months.
The average duration of the surgical procedure was 150 min, with an average blood loss of 500 ml. One patient exhibited symptoms of brachial plexus injury, which gradually improved after careful observation. All patients experienced primary wound healing, and no complications such as pulmonary infection, respiratory failure, or other adverse events were observed. Additionally, one patient showed elevated transaminase levels, leading to a modification in the anti-tuberculosis drug regimen from quadruple therapy to triple therapy.
The treatment of upper thoracic tuberculosis through the third rib small incision technique is a very good surgical approach, which has the advantages of safety and effectiveness.
上胸椎复杂的解剖结构使得实现手术暴露具有挑战性，导致显著的手术风险和困难。单纯后路手术由于暴露有限，无法充分处理和重建上胸椎病变。虽然前路手术在充分暴露胸段前部病变方面具有优势，但手术过程本身非常复杂。尽管存在多种上胸椎前路手术方法，但上胸椎病变的发生率相对较低。因此，关于在上胸椎结核背景下使用第三肋骨小切口入路治疗和重建上胸椎病变的报道有限。
我们收集了2017年7月至2022年11月期间收治的4例上胸椎结核患者的数据。上胸椎结核的治疗采用第三肋骨小切口入路，其中包括2例胸3 - 4椎体结核、1例胸4椎体结核和1例胸5椎体结核。患者中，3例取左侧卧位，1例取右侧卧位。入院前，所有4例患者均接受了为期两周的口服药物治疗，药物包括异烟肼、利福平、吡嗪酰胺和乙胺丁醇。手术后，他们继续接受抗结核治疗12个月。
手术平均时长为150分钟，平均失血量为500毫升。1例患者出现臂丛神经损伤症状，经仔细观察后逐渐好转。所有患者伤口均一期愈合，未观察到肺部感染、呼吸衰竭或其他不良事件等并发症。此外，1例患者转氨酶水平升高，导致抗结核药物治疗方案从四联疗法改为三联疗法。
采用第三肋骨小切口技术治疗上胸椎结核是一种非常好的手术方法，具有安全有效的优点。
