经后路一期病灶清除植骨融合内固定矫形治疗伴后凸畸形的儿童颈胸段脊柱结核

One-stage posterior debridment, bone grafting and internal fixation for cervicothoracic tuberculosis accompanied by kyphosis in children

目的探讨经后路一期病灶清除、植骨融合内固定矫形治疗伴后凸畸形的儿童颈胸段脊柱结核的可行性及疗效。方法2005年5月至2008年3月,我院收治的8例颈胸段脊柱结核患儿,均伴有后凸畸形。其中男性5例,女性3例,年龄3～10岁。临床表现为胸背痛,低热,盗汗及后凸畸形。术前脊柱后凸角为30～75°,平均52.1°。ASIA分级:B级1例,C级5例,D级2例。采用经后路一期病灶清除、椎管减压、植骨融合加钉、钩、棒系统矫形固定治疗。结果术后随访1～3年,平均2.5年。切口均一期愈合,无1例结核复发。ASIA分级:3例恢复2级,5例恢复1级。术后后凸角为10～26°,较术前明显改善,最后随访时后凸角为10～31°,较术后无明显丢失。术后3月血沉均恢复正常;植骨融合时间为4～8个月,平均6个月。结论经后路一期病灶清除、后方植骨内固定矫形一期手术治疗伴后凸畸形的儿童颈胸段脊柱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 investigate the effectiveness and feasibility of surgical management for cervicothoracic tuberculosis accompanied by kyphosis in children by using debridment, bone grafting and internal fixation through one-stage posterior approach. Methods From May 2005 to March 2008, 8 children with cervicothoracic tuberculosis accompanied by kyphosis were admitted to our hospital, of which 5 cases were male and 3 cases were female. Their age ranged from 3 to 10 years. Clinical features included thoracic and back pain, low-grade fever, night sweat and kyphosis. The kyphotic angle ranged from 30 to 75 degrees before operation, 52.1 degrees in average. ASIA score system was used to evaluate the neurological deficits. The results showed that there were 1 case in B grade, 5 cases in C grade and 2 cases in D grade. All cases were treated with debridement, decompression, bone grafting and internal fixation by one-stage posterior approach. Results The patients were followed up for 12 to 36 months, 30 months in average. All incisions were healed perfect without recurrence. ASIA score system indicated that 3 cases were improved by 2 grades, and 5 cases by 1 grade. The postoperative kyphotic angle was 10 to 26 degrees and there was no significant loss of the correction at the latest follow-up. The ESR was decreased to normal level 3 months postoperatively. Solid fusion was achieved within 4 to 8 months, 6 months in average. Conclusion It is an effective method to use one-stage debridment, bone grafting and internal fixation from posterior approach to treat pediatric cervicothoracic tuberculosis accompanied by kyphosis. It can not only correct the kyphosis but also prevent the late kyphosis progress.