单纯经后路一期前方病灶清除、植骨内固定矫形治疗伴后凸畸形的高胸段脊柱结核

Effect of One-stage Posterior Debridment,Primary Grafting and Internal Fixation for the Treatment of Upper Thoracic Tuberculosis Accompanied by Kyphosis

[目的]探讨单纯经后路一期前方病灶清除、植骨内固定治疗伴后凸畸形的高胸段脊柱结核的可行性及疗效。[方法]8例高胸段脊柱结核患者,均有椎旁及椎管内脓肿,严重破坏的椎体均小于三个节段,脊柱后凸Cobb角术前为26-76度;ASIA分级：A级2例,B级4例,C级2例。采用单纯经后路一期病灶清除、椎管减压、椎体间植骨融合加钉、钩、棒系统矫形固定治疗。[结果]切口均一期愈合,无一例结核复发。ASIA分级平均恢复1.88级。术后脊柱后凸Cobb角为8-24度,无明显加重;术后3个月血沉均恢复正常;植骨融合时间为3-7个月,平均5个月。[结论]对于严重破坏的椎体小于三个节段,同时合并后凸畸形的高胸段脊柱结核,采用单纯经后路一期前方病灶清除、植骨内固定治疗是一种有效可行的治疗方法。

[Objective]To investigate the effect and feasibility of surgical management of upper thoracic tuberculosis by using debridment,primary bone grafting and internal fixation through one-stage posterior approach.[Methods] Eight cases of upper thoracic tuberculosis had paraspinal abscess,abscess inside the vertebral canal and severe destructed vertebraes less than 3 segments.The kyphosis angle ranged from 26 to 76 degree before operation.ASIA score system was used to evaluate the neurological deficits.The results showed that there were 2 cases in A grade,4 cases in B grade and 2 cases in C grade preoperation.All cases were treated with primary debridement,decompression,interbody grafting and internal fixation by one-stage posterior approach.[Results] All incisions were healed perfectly without recurrence.All cases with paraplegia obtained an average improvement of grade 1.88 by ASIA neurological classification.The immediate postoperative kyphotic deformity was 8 to 24 degrees and there was no significant loss of the correction at the latest follow up.The ESR decreased to normal level 3 months postoperatively.Solid fusion was achieved within 3 to 7 months,with 5 months in average.[Conclusion] One-stage debridment,primary grafting and internal fixation from posterior approach is an effective method for treating upper thoracic tuberculosis accompanied by kyphosis while severe destructed vertebraes are less than 3.