采用经肋横突入路术式一期治疗老年胸椎结核合并截瘫患者的疗效分析

Effects of surgical treatment of debridement and bone grafting fusion with internal fixation in elder thoracic spinal tu- berculosis patients with paraplegia

目的探讨经同一切口采用经肋横突入路术式，一期行病灶清除前方减压、椎板植骨、椎弓根钉内固定术治疗老年胸椎结核合并截瘫的临床疗效。方法2012年2月至2013年10月，沈阳市胸科医院对收治的26例年龄）60岁的老年胸椎结核合并截瘫患者，采用经同一切口经肋横突入路术式，一期行病灶清除前方减压、椎板植骨、椎弓根钉内固定术治疗。其中男18例，女8例；年龄（64．4±5．1）岁；病程5～17个月，平均（12．4±4．2）个月。Frankel脊髓损伤分级：B级17例，C级7例，D级2例。胸背部、肋间放射性疼痛7例，Cobb角（24．4±3．1）°，观察患者治疗后临床症状改善情况、椎板植骨融合时间、随访Frankel脊髓损伤分级及Cobb角矫正情况。结果26例患者术后随访时间6412个月，平均（11．3±2．7）个月，术前合并胸背部、肋间放射性疼痛7例患者术后疼痛全部消失。椎板植骨融合时间约为6～8个月，26例截瘫患者术后1年随访Frankel脊髓损伤分级：D级1例，其余25例全部恢复至E级。术后1周测量Cobb角，平均为（24．4±3．1）°，矫正（19．3±4．3）°，无内固定松动及断裂。结论一期后路经肋横突入路行病灶清除前方减压椎板植骨椎弓根钉内固定术治疗老年胸椎结核合并截瘫，疗效满意，可以成为老年胸椎结核合并截瘫手术治疗的一种术式选择。

Objective To investigate the effects of surgical treatment for elder thoracic spinal tuberculosis （TB） patients with paraplegia by using the same approach of the debridement and bone grafting fusion with internal fixation. Methods From February 2012 to October 2013, a total of 26 eider patients （aged over 60 years old） with thoracic spinal TB and paraplegia were treated at Shenyang Chest Hospital by using the same approach of the debridement and fusion with internal fixation surgical treatment. Among them, 18 patients were male and 8 patients were female the average age was （64.4±5.1） years old; the duration of TB treatment was 5--17 months with an average of （12.4±4.2） months. The Frankei grading method and the American Spinal Injury Association （ASIA） function scale were used for grading spinal injury severity of the patients and the results were： Grade B in 17 cases, Grade C in 7 cases, Grade D in 2 cases. The erythrocyte sedimentation rate （ESR） of the patients was （62.7±6.5） mm/1 h and the Cobb angle was （24.4±3.1）°. The patients were followed up after they received surgical operations and the following information was collected： symptoms improvement, the time of vertebral lamina bone graft fusion, the Frankel grading and the Cobb angle. Results The postoperative follow-up duration for those 26 patients was 6--12 months with an average of （11.3±2.7） months. The intercostal pain disappeared in 7 patients who suffered it before operations. The time of vertebral lamina bone graft fusion was about 6--8 months. The Frankel grading of 26 patients with paraplegia after 1 year of operations was： Grade D in 1 patient and Grade E in the remaining 25 patients. After a week of the operation, the Cobb angle was corrected to （19.3±4.3）° from （24.4±3.1）°. During the follow-up period, no internal fixation loosening or broken were observed. Conclusion The treatment outcomes of surgical treatment with the same approach of the dehridement and bone grafting fusion with internal fixation among elder thoracic spinal TB patients with paraplegia are satisfied. It may be a good option for surgical treatment in those patients.