胸、腹腔镜辅助下胸、腰椎结核手术治疗

Video-assisted thoracoscopic or laparoscopic surgery in thoracolumbar spinal tuberculosis

目的探讨胸、腹腔镜辅助下胸、腰椎结核手术的临床效果。方法34例胸、腰椎结核病患者,其中男性23例,女性11例;年龄4～72岁,平均年龄39.2岁。对其应用胸、腹腔镜辅助下的胸、腰椎结核前路病灶清除,对不完全性截瘫病例同时进行脊髓减压术,对骨缺损较大者行植骨术,脊柱不稳定者增加钉棒或钉板内固定术。结果手术时间120～240min,平均手术时间145min;出血量150～1750ml,平均出血量564ml。全部病例随访1～5年,平均随访2.8年。影像学检查显示结核病灶清除彻底,脊髓减压充分,椎间植骨均融合,内固定无松动;并发不完全性截瘫患者均完全恢复。1例L4～L5结核并腰大肌脓肿及右大腿脓肿患者大腿脓肿复发再次行搔刮治愈。结论胸、腹腔镜辅助下胸、腰椎结核的手术治疗,可做到良好的病灶清除、脊髓减压、植骨及内固定,具有组织损伤小、康复快的优点。

Objective To explore the clinical efficacy of video-assisted thoracoscopic or laparoscopic surgery in the treatment of thoracolumbar spinal tuberculosis.Methods A total of 34 patients with thoracolumbar spinal tuberculosis,male 23,female 11,aged 4-72 years,mean age 39.2 years,were enrolled.All of these cases were treated with video-assisted thoracoscopic or laparoscopic surgery.All cases were performed anterior debridement,spinal cord decompression in patients with incomplete paraplegia,allograft bone fusion were performed in patients with massive bone defect and internal fixation with titanic nail-plate,nail-clavate system in cases of instability of the spine.Results The average operation time was 145 minutes（120-240 minutes）.The average blood loss was 564 ml（150-1 750 ml）.The patients were followed up from 1 to 5 years（average 2.8 years）.Postoperative radiological evaluation revealed the focus had been cleaned thoroughly.The spinal cord had been decompressed completely.The intervertebral bone grafting grew well.No loosened internal fixations were found,patients with incomplete paralysis were completely recovered,post-operation recurrence was found and the secondary operation was performed in one of these patients with L4-L5 tuberculosis complicated by psoas and thigh abscess.Conclusion Video-assisted thoracoscopic or laparoscopic surgery in the treatment of thoracolumbar spinal tuberculosis is feasible for satisfactory focus cleaning,spinal cord decompression,allograft and internal fixation.It has the advantages of minimal injury and rapid recovery.