一期PVCR技术治疗胸腰段陈旧结核继发僵硬性角状后凸畸形

Analysis on one stage posterior vertebral column resection in treatment of ankylotic and horny kyphosis secondary to old thoracicolumbar tuberculosis

目的总结分析一期后路全脊椎切除截骨术(PVCR)治疗胸腰段陈旧结核继发僵硬性角状后凸畸形的可行性、安全性和有效性。方法回顾研究2004—2009年收治的胸腰段陈旧结核继发僵硬性角状后凸畸形患者12例,年龄37～56岁,平均42.4岁;后凸Cobb角59°～95°,平均62.9°;术前有神经功能障碍者5例,其中Frankel分级C级3例,D级2例;12例均伴有较重的胸腰背部疼痛。手术方式均为一期PVCR,手术前、后分别测量脊柱后凸Cobb角及进行神经功能Frankel分级,术后随访8～37个月,平均25.3个月。结果无围术期死亡发生,手术时间3.5～9.0 h,平均5.5 h;术中出血量720～5 320 mL,平均2 410 mL;术后随访脊柱后凸Cobb角-1°～32°,平均8.9°,平均矫正度数为54°,平均矫正率为85.9%。术后有神经功能障碍者1例,Frankel分级D级,术后神经功能改善率为80%(4/5)。均未出现神经并发症。围术期并发症发生率为16.7%(2/12),包括脑脊液漏1例和表层伤口感染1例。随访期并发症发生率为8.3%(1/12),表现为内固定植入物松动,其余患者X射线片可见原截骨平面均已发生骨性融合,胸腰背部疼痛症状完全消失。结论一期PVCR是一种治疗胸腰段陈旧结核继发僵硬性角状后凸畸形的安全、有效、可行的手术方法,但技术要求高,谨慎使用可获得满意的临床效果。

Objective To evaluate the feasibility, safety and efficacy of one stage posterior vertebral column resection （PVCR） for treating ankylotic and horny kyphotic deformity secondary to old thoracicolambar tuberculosis. Methods 12 pa- tients with ankylotic and horny kyphotic deformity secondary to old thoracicolambar tuberculosis treated from 2004 to 2009 were analyzed retrospectively,with the mean age of 42.4 years （37-56 years old）, the mean kyphotic cobb angle of 62.9°（range 59°-95°）. There were 5 cases of nerve disfunction before operation, the Frankle grade C in 3 cases and grade D in 2 cases. All the patients had severe thoracolumbar dorsum pain. All cases were performed PVCR. The kyphotic cobb angle and Frankle grade were mea- sured before and after operation. Results No perioperative death occurred. The average operation time was 5.5 h（3.5- 9.0 h）, and the mean intraoperative blood loss volume was 2 410 mL（720-5 320 mL）. All cases were followed up for 8-37 monthes（aver- age 25.3 months）. The kyphotic Cobb angle was improved from the preoperative average of 62.9° （590-95° ）to a postoperative av- erage of 8.9° （-1°-32° ） with the average correction degree of 54° and the average correction rate of 85.9%. 1 case had postopera- tive neurological deficits as the Frankel grade D.The improvement rate of postoperative neurological function was 80% （4/5）. No neurological complications appeared among the 12 cases, and the perioperative complications occurred in 2 cases （16.7%）, in- cluding 1 case of cerebrospinal fluids leakage and 1 case of superficial wound infection. The complications rate during follow-up period was 8.3% （1/12）,and manifested by loosened internal fixation. X-radiography showed the bony fusion at the original os- teotomic level in other cases and the thoracicolambar back pain symptoms were vanished. Conclusion One stage PVCR is the safe,effective and feasible method for treating ankylotic and horny kyphotic deformity secondary to old thoracicolambar tubercu- losis. Due to the highly technical requirements, cautious usage is necessary for satisfactory clinical efficacy.