一期后路病灶清除植骨内固定治疗上胸椎结核

Treatment of Upper Thoracic Vertebral Tuberculosis by One-stage Posterior Focus Debridement, Bone Graft and Internal Fixation Surgery

目的探讨一期后路病灶清除植骨内固定治疗上胸椎结核的手术适应证，手术效果及预后。方法收集2006年3月至2012年10月首都医科大学附属北京胸科医院骨科行一期后路病灶清除植骨内固定治疗的上胸椎结核患者17例，男12例，女5例，年龄4～67岁，中位年龄49岁，累及椎体38个，平均2．2个;术前选择异烟肼（H）、利福平（R）或利福喷丁（Rft）、乙胺丁醇（E）、吡嗪酰胺（Z）、左氧氟沙星（Lfx）组成四联或五联抗结核治疗方案，抗结核治疗时间2～96周，平均10.3周；术后继续行HR（Rft）EZ或HR（Rft）EZLfx抗结核治疗，抗结核治疗时间12～18个月。结果患者手术时间165～300min，平均（224．11±41．35）min。术中失血量300～1500ml，平均（752．94±435．70）ml。术后并发症：切口积液4例，褥疮1例。Cobb角术前（23．96±6．67）°，术后（19．21±5．97）°。随访12～30个月，平均14个月，截至末次随访胸椎结核均获得治愈，植骨融合100．00％。结核无复发。10例截瘫患者末次随访时按照美国脊柱损伤协会（ASIA）分级标准均达D级以上。结论上胸椎结核患者采用一期后路病灶清除植骨内固定可以取得满意疗效。

Objective To explore the indications, efficacy and treatment outcomes of one-stage posterior focus debridement, bone graft and internal fixation operation for the patients with upper thoracic vertebral tuberculosis （TB）.Methods The information of the patients with upper thoracic vertebral TB and in different degrees of paraplegia, who received one-stage posterior focus debridement, bone graft and internal fixation operation in Beijing Chest Hospital between March 2006 and October 2012, were collected.There were 17 patients in total, including 12 males and 5 females with ages ranged from 4 to 67 years （median ： 49 years）. Combination chemotherapy with 4-5 anti-TB drugs （isoniazid, rifampicin or rifapentine, ethambutol, pyrazinamide, or/and levofloxacin） were administered to al 1 patients before and after the operations.The duration of the pre-operative anti-TB treatment were 296 weeks （mean： 10.3 weeks） t the duration of the post-operative anti-TB treatment were 12-18 months. Results The operation time ranged from 165 minutes to 300 minutes, with an average of （224.11±41.35） minutes. The intra-operative blood loss was 300-1500 ml, with an average of （752.94 ± 435.70） ml. The major complications after operations were incision effusion （4 cases） and bedsore （1 case）. The average of Cobb＇s angle was （23.96 ± 6.67）° and （19.21 ± 5.97）° respectively before and after operations. The mean follow-up duration was 14 months （range ： 12- 30 months）. All the patients were cured after treatment. The rate of inter-body fusion was 100.00% and no relapse by the end of follow-ups.Ten patients with paraplegia recovered to degree D or E according to the neurological classification of American Spinal Injury Association （ASIA）. Conclusion One- stage posterior focus debridement, bone graft and internal fixation is an effective and feasible treatment for the patients with upper thoracic vertebral TB.