有限减压及椎板重建在单节段胸椎结核手术治疗中的应用

APPLICATION OF LIMITED DECOMPRESSION COMBINED WITH VERTEBRAL PLATE RECONSTRUCTION ON TREATMENT OF SINGLE SEGMENT THORACIC VERTEBRA TUBERCULOSIS

目的探讨在一期后路病灶清除、植骨融合内固定基础上,采用有限减压、硬膜囊外可吸收性止血绫覆盖及椎板重建治疗单节段胸椎结核的疗效。方法回顾分析2005年9月-2010年3月收治的90例单节段胸椎结核患者临床资料,其中对照组46例采取一期后路病灶清除、植骨融合内固定治疗,治疗组44例在此基础上联合有限减压、硬膜囊外可吸收性止血绫覆盖及椎板重建治疗。两组患者性别、年龄、病程、病变节段、术前Cobb角、Frankel分级、红细胞沉降率(erythrocyte sedimentation rate,ESR)、Oswestry功能障碍指数(ODI)等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果术后患者切口均Ⅰ期愈合。90例均获随访,随访时间24～44个月,平均38个月。术后1周及3个月两组ESR比较差异均无统计学意义(P>0.05)。影像学检查示,治疗组植骨均融合,硬膜外未见明显瘢痕组织,无内固定失效,对照组出现3例内固定失效,两组比较差异有统计学意义(P=0.032)。两组术后Cobb角均较术前显著改善(P<0.05);治疗组术后2年及末次随访时Cobb角及其矫正丢失度均优于对照组(P<0.05)。末次随访时两组ODI均较术前显著改善(P<0.05),且治疗组ODI及其改善率均优于对照组(P<0.05)。末次随访时两组Frankel分级均较术前显著改善(P<0.05),且治疗组优于对照组(Uc=4.368,P=0.000)。结论与传统手术方法比较,一期后路有限减压、病灶清除、植骨融合内固定联合硬膜囊外可吸收性止血绫覆盖及椎板重建,具有创伤小、并发症少及患者术后功能恢复佳等特点,是治疗单节段胸椎结核的一种有效手术方法。

Objective To investigate the effectiveness in the treatment of single segment thoracic vertebra tuberculosis by limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation. Methods Between September 2005 and March 2010, 90 cases of single segment thoracic vertebra tuberculosis were treated by using limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation in 44 patients （treatment group） and by one-stage posterior approach, bone fusion, and internal fixation in 46 patients （control group）. There was no significant difference in gender, age, disease duration, affected segment, Cobb angle, Frankle grade, erythrocyte sedimentation rate （ESR）, and Oswestry disability index （ODI） between 2 groups （P 〉 0.05）. Results All incisions healed by first intension. All 90 cases were followed up 24-44 months （mean, 38 months）. There was no significant difference in ESR between 2 groups at 1 week and 3 months after operation （P 〉 0.05）. Postoperative iconography indicated that the bone fusion rate of the treatment group was 100% and no epidural cicatricial tissue or failure of internal fixation was observed, showing significant difference when compared with control group （3 cases having failure of internal fixation） （P=0.032）. The Cobb angles were significantly corrected after operation when compared with preoperative angles in 2 groups （P 〈 0.05）. At 2 years after operation and at last follow-up, the Cobb angle and correction loss in treatment group were significantly better than those in control group （P 〈 0.05）. The ODI and Frankel grade were significantly improved at last follow-up when compared with preoperative ones in 2 groups （P 〈 0.05）; the treatment group was significantly better than the control group in the ODI, improvement rate of ODI （P 〈 0.05）, and in Frankel grade （Uc=-4.368, P=0.000）. Conclusion Compared with conventional operation method, it is an ideal operation method to use limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation for treatment of single segment thoracic vertebra tuberculosis, with minimal wound, less complications, and good function recovery.