肩胛下胸腔入路与后外侧入路上胸椎结核手术的对照研究

A retrospective clinical study of the therapeutic effect of subscapularis transthoracic and posterolateral approach for upper thoracic tuberculosis

目的 比较经肩胛下胸腔入路与后外侧入路病灶清除植骨融合内固定术治疗上胸椎结核的疗效.方法 回顾性分析2002年1月至2014年2月行病灶清除植骨融合内固定术治疗的43例上胸椎结核患者,其中采用肩胛下胸腔入路21例、后外侧入路22例.比较两组患者的性别、年龄、病变节段、手术时间、出血量、住院时间、治愈率、术后并发症发生率、Cobb角的矫正及神经功能恢复情况.结果 两组患者性别、年龄、病变节段、术前红细胞沉降率、脊髓功能Frankel分级、Cobb角的差异均无统计学意义.肩胛下胸腔组手术时间（196±10） min,后外侧组（142±13） min,差异有统计学意义.两组出血量、住院时间及治愈率的差异无统计学意义.肩胛下胸腔组与后外侧组分别随访（28.0±14.7）个月和（27.3±15.5）个月.肩胛下胸腔组Cobb角由术前36.5°±4.8°矫正至24.8°±5.6°,矫正率30.9％;后外侧组Cobb角由术前34.5°±5.2°矫正至10.2°±2.6°,矫正率68.5％;后外侧组矫正率优于肩胛下胸腔组,差异有统计学意义.两组术后脊髓功能Frankel分级较术前明显改善,但组间差异无统计学意义.结论 经肩胛下胸腔入路与后外侧入路手术治疗上胸椎脊柱结核均能取得良好的临床疗效.后外侧入路在手术创伤、手术时间及后凸畸形矫正能力方面优于肩胛下胸腔入路.

Objective To compare the therapeutic effect of debridement,bony fusion and internal fixation through subscapularis transthoracic and posterolateral approach in treating upper thoracic tuberculosis.Methods Between January 2002 to February 2014,a total of 43 patients with upper thoracic tuberculosis were analyzed retrospectively.There were 21 patients in subscapularis transthoracic approach group and 22 patients in posterolateral approach group.Several parameters of the two groups were compared,including gender,age,segmental tuberculosis,intraoperative blood loss,operative time,complications of operation,hospital stay,the cure rate,the Cobb angle,Frankel scale and so on.Results There was no significant difference in gender,age,segmental tuberculosis,ESR,Frankel scale,Cobb angle between the two groups before surgery.The operative time was 196± 10 min in subscapularis transthoracic approach group,whereas it was 142±13 min in posterolateral approach group.The operative time of subscapularis transthoracic approach group was significantly longer than posterolateral approach group.There was no significant difference in intraoperative blood loss,complications of operation,hospital stay and the cure rate.The followed up of subscapularis transthoracic approach group and posterolateral approach group was 28.0± 14.7 months and 27.3± 15.5 months respectively.The preoperative Cobb angle was 36.5°±4.8° and the postoperative Cobb angle was 24.8°±5.6° in subscapularis transthoracic approach group.The correction rate was 30.9％.The preoperative Cobb angle was 34.5°±5.2° and the postoperative Cobb angle was 10.2°±2.6° in posterolateral approach group.The correction rate was 68.5％.Thus,the correction rate of posterolateral approach group was significant better than subscapularis transthoracic approach group.The neurological score of Frankel scale was significantly restored in two groups after operation,and there was no significant difference between two groups.Conclusion For upper thoracic tuberculosis,the therapeutic effect of debridement,bony fusion and internal fixation through subscapularis transthoracic and posterolateral approach could achieve the same good clinical results.However,the posterolateral approach was better than subscapularis transthoracic approach in surgical trauma,surgical duration and kyphosis correction.Therefore,it is recommended to use the posterolateral approach in treating upper thoracic tuberculosis.