经胸入路一期手术治疗胸椎结核合并结核性脓胸

The Thoracic Surgical Treatment for Thoracic Spinal Tuberculosis Combined with Tuberculous Empyema

目的探讨经胸入路一期手术治疗胸椎结核合并结核性脓胸的疗效和安全性。方法回顾性分析9例经外科手术治疗的胸椎结核合并结核性脓胸患者，术前行闭式胸腔引流，常规四联抗痨治疗2周以上；均应用经胸的手术入路，前路清除病灶、一期植骨、钛板内固定治疗，其中4例（合并椎旁脓肿穿破纵隔胸膜）急性脓胸患者加行脓胸病灶清除术，5例慢性结核性脓胸患者加行胸膜纤维板剥脱术，其中1例用带蒂肋肌瓣胸腔内移植术；术后继续抗痨12—18个月。结果伤口全部一期愈合，结核性脓胸均治愈，随访1．5～3年，结核病灶无复发，植骨块5～7个月融合，内固定位置良好，无移位和断裂。结论经胸入路一期手术治疗胸椎结核合并结核性脓胸是一种安全、有效方法。

Objective To discuss the clinical efficacy and safety in thoracic surgical treating thoracic spinal tuberculous combined with tuberculous empyema. Methods Retrospective analysis of nine patients with thoracic spinal tuberculous combined with tuberculous empyema was made. All patients were treated by anterior partial vertebrecto- my,iliac grafting and fixation. Four of them with acute tuberculous emyema had cleared the empyema lesions. Five of them with chronic tuberculous emyema had closed chest drainage and were offered the decortications of lungs. One patient was offered intercostal muscle flaps filling the chest cavity. Anti - tuberculosis drugs were routinely administered before and after operation. Results All patients were followed up for 1.5 - 3 years, the wounds healed uneventfully after surgery in all cases. None of them had relapse. The patients with tuberculous empyema were healed. Bone fusion was achieved 5 - 7 months after surgery. The internal fixations were stable,without loosening or breaking metallic implants. Conclusion The thoracic surgical treatment is safe and effective therapy for thoracic spinal tuberculous com- bined with tuberculous empyema.