后路脊柱切除重建术治疗胸腰椎陈旧性结核继发截瘫

Efficacy of posterior vertebral column resection for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia

目的观察后路脊柱切除重建术治疗胸腰椎陈旧性结核继发截瘫的临床效果，为胸腰椎陈旧性脊柱结核继发截瘫手术治疗提供一种安全有效的手术方式。方法2007年8月至2010年3月对12例胸腰椎结核继发截瘫病例采用经后路病椎节段全切，钛网支撑植骨内固定术式治疗，术前、术后随访期间拍摄X线片测量后凸Cobb角，并观察内固定情况，采用Frankel分级评价神经功能状态。结果随访6-18个月，平均11个月，通过手术所有患者的胸背部疼痛症状得到缓解。术后Frankel分级1例由B级恢复到C级；6例由C级恢复到D或E级，4例由D级恢复到E级，另1例B级无明显恢复；术前后凸Cobb角平均（76．0±23．4），术后1周Cobb角（15．5±6．3），与术前比较差异有统计学意义（t=3．41，P〈0．01）；末次随访时Cobb角（16．0±8．2），与术后1周比较差异无统计学意义（t=1．58，P〉0．05）。末次随访显示，所有病例钛网植骨融合，无内固定并发症。结论后路脊柱切除重建术治疗胸腰椎陈旧性结核继发截瘫手术方式可行，具有减压充分、矫正率高，而且创伤较小不需改变体位再行前路手术。

Objective To observe the therapeutical effect of posterior vertebral column resection on chronic thoracolumbar tuberculosis with secondary paraplegia and to provide a safe and effective method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia. Methods From Aug. 2007 to Mar. 2010,12 cases with chronic thoracolumbar tuberculosis and secondary paraplegia were surgically treated by posterior vertebral column resection and Titanium net support for bone graft and internal fixation operation treatment. Cobb angle was measured, and conditions of internal fixation were observed before and after the operation by X-ray films. Neurological status were evaluated by Frankel grades. Results The follow-up periods was 6- 18 months（ on average 11 months）. Operations eased all patients＇ back and chest pain. Frankel grade increased from C preoperatively to grade D or E postoperatively in 6 cases, from grade D to E in 4 cases and from grade B to C in 1 case. No obvious improvement of Frankel grade was observed in the＇ other patient of grade B. The average Cobb angles were（76.0 ＋ 23.4 ） ~ before surgery, （15.5 ＋ 6. 3 ） ~ at one week after surgery and （16. 0 ＋ 8. 2）~at the last follow-up. The difference in the Cobb angle before and at one week after treatment was significant（t = 3.41 ,P 〈0. 01 ）. No difference was found in the Cobb angle between at one week after treatment and at the last follow-up （t = 1.58 ,P 〉0. 05 ）. All patients got bony fusion with Titanium net. No complications occurred with internal fixation. Conclusion Posterior vertebral column resection is a feasible method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia. It achieves neurological decompression with high correction rate and minor injury, and no anterior surgery is needed.