胸椎结核外科治疗的长期临床随访

Long-term follow-up of surgical treatment for thoracic spinal tuberculosis

目的回顾性分析胸椎结核的外科治疗及疗效,探讨手术入路、内固定的选择、术后及远期并发症的原因及对策。方法 1997年4月～2010年4月收治胸椎结核患者107例。病灶位于上段胸椎10例,中段胸椎46例,下段胸椎51例。结核病灶累及单节段64例,2个节段21例,≥3个节段22例。开胸入路65例,胸腹膜外入路22例,单纯后路9例,前后联合入路11例。使用内固定61例,单纯病灶清除植骨融合46例。从治愈率、内固定并发症及神经功能恢复等方面进行长期随访。结果 89例获得1.0～13.8年随访,平均7.6年,87例达到了临床治愈,复发2例。内固定断裂2例,螺钉松动3例。结论前路一期病灶清除、植骨融合结合内固定是胸椎结核外科治疗的主要手段,手术入路、内固定应用应当根据病灶节段、患者年龄、病灶特点及稳定性等因素个性化选择,可有效减少术后并发症发生,提高疗效。

Objective To retrospectively analyze the effect of surgical treatment on thoracic spinal tuberculosis,and to investigate the choice of operative approach and internal fixation,the causes of failure cases and the strategies.Methods Totally 107 patients with thoracic spinal tuberculosis underwent surgical treatment between April 1997 and April 2010.There were 10 cases involved in superior segment of thoracic spine,46 cases in middle segment and 51 cases in inferior segment.The injured vertebral body included single segment in 64 cases,2 segments in 21 cases and ≥3 segments in 22 cases.There were 65 cases with anterior approach,22 cases with extrapleural approach,9 cases with posterior approach,and 11 cases combined anterior with posterior approach.Instruments were implanted in 61 cases,and clearance of focal lesion and spinal fusion were applied in 46 cases.Results Finally,89 patients were followed up for 1.0-13.8 years（mean 7.6 years）.The tuberculosis was cured in 87 patients and recurred in 2 patients.There were 2 cases of instrument breakage and 3 cases of loosening.Conclusion Radical debridement,spinal fusion and internal fixation are the main surgical therapies for thoracic spinal terbuculosis.Operation program should be individualized according to the injured position,patient ages and features of the disease,which can help to reduce complications and improve curative effects.