经胸入路病灶清除植骨融合单钉棒内固定治疗多节段胸椎结核

Single pedicle screw fixation combined with radical debridement and bone graft fusion for treatment of multiple thoracic vertebral tuberculosis via anterior thoracic approach

摘要:

目的评价经胸入路病灶清除植骨融合单钉棒内固定在多节段胸椎结核中的应用价值。方法南华大学附属长沙中心医院脊柱外科2005年1月至2018年8月共有30例采用经胸入路病灶清除植骨融合单钉棒内固定在多节段胸椎结核患者,平均年龄为56.5岁。其中合并有血行播散型肺结核3例,有浸润型肺结核9例;病变连续累及3个椎体16例,4个椎体5例,5个椎体4例,呈跳跃型累及3个椎体者5例。术前红细胞沉降率(ESR)检查15~115 mm/h,平均46 mm/h。术前Cobb's角20~35°,平均26°。神经功能按Frankel分级,B级10例,C级5例,D级8例,E级7例。术前肺功能检测为重度限制性肺通气功能障碍者8例,中重度限制性肺通气功能障碍者22例。结果所有患者监测血常规、血沉及C-反应蛋白结果呈下降趋势,术后4周血常规、血沉及C-反应蛋白恢复正常。随访18~36个月,平均24个月。未发现结核复发,胸椎骨质破坏加重及脊髓神经损伤加重征象,所有患者内固定无松动、脱出及断裂,植骨块骨性融合。术后Cobb's角10~12°,平均10.5°,与术前比较差异有统计学意义(P<0.05)。神经功能术前Frankel分级D级8例和C级5例患者恢复到E级,2例B级患者恢复至E级,8例B级患者恢复至D级。术后6个月所有患者植骨全部骨性融合。结论前方经胸入路病灶清除植骨融合单钉棒内固定术是治疗多节段胸椎结核的一种安全、有效的手术术式。

Abstract:

【Objective】To study and evaluate the efficacy of single pedicle screw fixation combined with radical debridement and bone graft fusion for treatment of multiple thoracic vertebral tuberculosis via anterior thoracic approach.【Methods】Thirty patients with multiple thoracic vertebral tuberculosis treated with single pedicle screw fixation after radical debridement and bone graft fusion through anterior thoracic approach at our hospital from January 2005 to August 2018 were retrospected and analysed.Among them,there were 3 cases of hematogenous disseminated pulmonary tuberculosis and 9 cases of infiltrative pulmonary tuberculosis;16 cases of 3 vertebral bodies,5 cases of 4 vertebral bodies,4 cases of 5 vertebral bodies were involved continuously,and 5 cases of 3 vertebral bodies were involved in jumping type.Erythrocyte sedimentation rate(ESR)ranged from 15 to 115 mm/h,the preoperative Cobb angle of kyphotic deformity ranged from 20°to 35°(median:26°).All patients with nerve functions disability were evaluated with Frankel classification systems(10 cases in Frankel B,5 cases in Frankel C,8 cases in Frankel D,and 7 cases in Frankel E).There were 8 cases of severe restrictive pulmonary ventilation dysfunction and 22 cases of moderate and severe restrictive pulmonary ventilation dysfunction.【Results】The results of blood routine examination,ESR and C-reactive protein showed a downward trend,and became normal after 4 weeks.All cases performed 18 to 36 months(mean 24 months)follow-up,the Cobb′s angle ranged from 10°to 12°(median:10.5°),and the difference was statistically significant when compared with preoperative one.According to preoperative Frankel classification of neurological function,8 patients of Frankel grade D and 5 patients of Frankel grade C recovered to E,2 patients of Frankel grade B recovered to E,and 8 patients of Frankel grade B recovered to D.All patients were cured entirely and they got bony union about 6 months after operation.【Conclusion】Single pedicle screw fixation combined with radical debridement and bone graft fusion via anterior thoracic approach is an effective and safety method for treatment of multiple thoracic vertebral tuberculosis.It can achieve radical debridement,decompression,stabilization and fusion simultaneously.