自体髂骨植骨与钢板置入内固定修复胸椎结核

Autologous iliac bone graft and plate fixation in the repair of tuberculosis of the thoracic vertebra

背景:胸椎与相应节段的肋骨相连构成胸廓,椎体部位深在,邻近组织结构复杂,所以胸椎椎体的充分暴露显得较为困难。通常多采用切除相应肋骨,经胸腔到达病灶,创伤较大,常有胸痛、局部皮肤麻木等并发症。为此能否通过肋间隙入路不切除肋骨而达到同样的目的成为新的临床命题。目的:探讨经肋间隙入路自体髂骨植骨与钢板置入内固定治疗胸椎结核的安全性及有效性。方法:对2008年1月至2013年12月明确诊断为胸椎结核的30例患者,常规给予抗结核治疗两至三周后,采用经肋间隙入路行自体髂骨植骨融合,前路钢板置入内固定。术后随访6-22个月,观察骨折愈合情况、疼痛缓解程度、Cobb角改变、切口长度、出血量、手术时间、术后神经功能恢复等指标进。结果与结论:30例患者切口长度(12.4±1.8)cm,切口纵向撑开宽度(10.0±3.2)cm;开胸时间(16.0±2.5)min,关胸时间(12.0±1.5)min;术中出血量(430.0±87.4)mL。后凸畸形角度术前平均27°,术后平均8°,平均矫正19°。术后一至两周背部疼痛基本缓解。28例患者痊愈,2例好转;术后随访复查X射线片显示自体髂骨植骨全部融合,融合时间为四至五个月。提示经肋间隙入路自体髂骨植骨与钢板置入内固定是治疗胸椎结核一种有效、安全有效的方法,经肋间隙入路的显露范围能满足结核病灶彻底清除、自体髂骨植骨、钢板置入内固定的操作要求,且可保全胸廓完整性及脊柱稳定性。

BACKGROUND：Thoracic vertebra connected to the corresponding section of the ribs constitute thoracic vertebral, which is deep, and the structure is complicated, so it is difficult to ful y expose thoracic vertebrae. Usual y, corresponding ribs is removed, and the injured site wil be reached through thoracic cavity. The trauma is big. Some complications often occur such as chest pain, and local skin numbness. Therefore, whether it is possible to reach the same target without removal of ribs through intercostal space became a new clinical problem. OBJECTIVE：To explore the safety and efficacy of autologous iliac bone graft and plate fixation for tuberculosis of thoracic vertebra. METHODS：A total of 30 patients diagnosed with tuberculosis of thoracic vertebra from January 2008 to December 2013 were conventional y treated with anti-tuberculosis treatment for 2 to 3 weeks, and then treated with autologous iliac bone fusion through intercostal space and anterior plate fixation. Postoperative fol ow-up was conducted from 6 to 22 months. Fracture healing condition, the degree of pain relief, Cobb angle change, length of incision, blood loss, operation time, postoperative recovery of neurological function were observed. RESULTS AND CONCLUSION：In 30 patients, the length of incision was （12.4±1.8） cm;longitudinal incision distraction width was （10±3.2） cm;the time of opening the chest was （16.0±2 .5） minutes;the time of closing the chest was （12.0±1.5） minutes;intraoperative blood loss amount was （430.0±87.4） mL. Preoperative and postoperative average kyphosis angles were respectively 27° and 8°, with an average rectification of 19°. The pain basical y relieved at 1 to 2 weeks after the surgery. 28 patients were healed, and the symptoms of 2 patients were improved. Postoperative fol ow-up radiographs revealed that autologous bone grafts were thoroughly fused, and the fusion time lasted from 4 to 5 months. These data verified that autologous iliac bone graft through intercostal space and plate fixation is an effective, safe method for tuberculosis of thoracic vertebra. The exposed range through intercostal space can satisfy the operation requirements of complete tuberculosis clearance, autologous iliac bone graft and plate fixation, and can ensure the integrity of the whole thorax and spine stability.