小儿胸腰椎结核合并后凸畸形的手术治疗

Treatment of thoraco-lumbar spinal tuberculosis with kyphotic deformity with surgical techniques of internal fixation apparatus system in children

目的探讨小儿胸腰椎结核合并后凸畸形手术治疗的近期和远期疗效。方法追踪观察22例合并后凸畸形的小儿胸腰椎结核患者采用前路小切口清除椎体结核病灶联合后路矫形固定融合一期手术治疗的结果。观察指标主要包括局部病灶有无复发、后凸畸形术后近期矫正度、症状改善情况以及后凸畸形远期变化情况。结果手术耗时180～220min,平均200min,失血量280～450mL(平均350mL)。术后2例并发肺不张,1例并发胸腔积液,均为轻度。术前平均后凸角为51°(31°～72°)外观呈明显角状后凸畸形;术后近期平均为24°(21°～42°),术后随访1～5年(平均2.8年),后凸角平均为26°(18°～40°)。14例合并不同程度瘫痪者下肢肌力均提高1、2级,2例尿潴留患儿于术后3～6个月恢复排尿功能。1例于术后2～4年出现椎板下钢丝断裂。所有患者最后1次随访时均未见原脊柱结核病灶复发。结论经前路小切口清除椎体结核病灶联合后路矫形固定融合一期手术治疗合并后凸畸形的小儿胸椎结核是矫正后凸畸形和预防晚期后凸畸形发生的有效方法。

[Objective] To evaluate the short-term and long-term effectiveness of the treatment of thoraco-lumbar spinal tuberculosis with kyphotic deformity with surgical techniques of internal fixation apparatus system in children. [Methods] We retrospectively analyzed the outcome of the treatment of 22 children suffered from thoraco- lumbar spinal tuberculosis with kyphotic deformity from July 1999 to March 2004 managed by surgical technique of one-stage one-step anterior debridement with small incision and posterior correction, instrument and fusion. [Re- sults] The operative time averaged 200 minutes （180min-220min minutes）, the blood loss averaged 350mL （280ml- 450ml）. Two patients were complicated with atelectasis, and one patient with hydrothorax. The mean preoperative kyphotic angle was 51°（31°-72°） and reduced to 24°（21°-42°） postoperatively. Roentgenogram taken for nine months postoperatively showed the TB involved vertebrae fused with the adjacent healthy vertebrae. The kyphotic angle at the final follow-up averaged 26°（18°-40°）. Fourteen patients with various degree of paraplegia preoperatively improved their low extremities muscle strength by 1 to 2 grades postoperatively. Two cases who suffered from urinary retention completely recovered after 3-6 months postoperatively. Sublaminar wires were found ruptured in 1 case 2- 4 years after operation. No TB reactivation was found in any patient during follow-up period （1 ～5years）. [ Conclusion] The siarglcal technique of one-stage one-step anterior debridement with small incision and posterior correction, instrument and fusion is an effective method to treat thoraco-lumbar spinal tuberculosis with kyphotic deformity and prevent late onset kyphosis in children.