横突植骨在单节段胸椎结核手术中的疗效观察

THERAPEUTIC EVALUATION OF INTERTRANSVERSE BONE GRAFT FOR SINGLE SEGMENTAL THORACIC SPINAL TUBERCULOSIS

目的探讨应用后路彻底病灶清除、横突植骨内固定术治疗单节段胸椎结核的临床效果。方法2014年3月-2015年5月,行后路彻底病灶清除、横突植骨内固定术治疗17例胸椎结核患者。男10例,女7例;年龄18～70岁,平均48.5岁。病程1～9个月,平均4个月。病变累及节段：T_（4、5 ）2例,T_（6、7） 5例,T_（7、8） 3例,T_（9、10） 2例,T_（10、11） 4例,T_（11、12） 1例。记录患者手术时间、术中出血量、住院时间;术后即刻常规行胸椎正侧位X线片评估减压及内固定情况,随访期间行胸椎正侧位X线片或CT检查判定融合效果;记录并比较手术前后红细胞沉降率（erythrocyte sedimentation rate,ESR）、C反应蛋白（C reactive protein,CRP）、背部疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、后凸Kyphosis角,神经功能采用美国脊柱损伤协会（ASIA）标准进行分级。结果手术时间165～220 min,平均184 min;术中出血量150～800 m L,平均231 m L;住院时间12～26 d,平均18 d。术后均无术区血肿、伤口裂开等早期并发症发生。17例均获随访,随访时间9～22个月,平均17.9个月。均未发生植骨失败、内固定物折断、胸腔积液、脑脊液漏、伤口感染、窦道形成等并发症。患者术后均获满意椎间融合,融合时间3～8个月,平均5.3个月。术后即刻及末次随访时的ESR、CRP、VAS评分、ODI及后凸Kyphosis角均较术前显著改善（P〈0.05）;末次随访时ESR、CRP、VAS评分、ODI较术后即刻进一步改善（P〈0.05）,但后凸Kyphosis角与术后即刻比较差异无统计学意义（P〉0.05）。末次随访时患者神经功能损害均得到较大改善,术前1例ASIA C级及6例D级患者均恢复至E级。结论横突植骨应用于单节段胸椎结核手术中,是一种安全、可靠、有效的新型植骨方式。

Objective To explore the effectiveness of intertransverse bone graft after debridement and fusion combined with posterior instrumentation in patients with single segmental thoracic tuberculosis. Methods Between March 2014 and May 2015, 17 cases of thoracic tuberculosis were treated by the surgery of intertransverse bone graft after debridement and fusion combined with posterior instrumentation. There were 10 males and 7 females with an average age of 48.5 years（range, 18-70 years）, and with a mean disease duration of 4 months（range, 1-9 months）. The affected segments included T_（4, 5） in 2 cases, T_（6, 7） in 5 cases, T_（7, 8） in 3 cases, T_（9, 10） in 2 cases, T_（10, 11） in 4 cases, and T_（11, 12） in 1 case. The operation time, intraoperative blood loss, and hospitalization time were recorded. Postoperative plain radiography was taken to assess the decompression and internal fixation, and the fusion effect was evaluated by X-ray or CT examination. The erythrocyte sedimentation rate（ESR）, C reactive protein（CRP）, visual analogue scale（VAS）, Oswestry disability index（ODI）, and Kyphosis angle were recorded and compared; the nerve function was evaluated by American Spinal Injury Association（ASIA）. Results The mean operation time, intraoperative blood loss, and hospitalization time were 184 minutes（range, 165-220 minutes）, 231 m L（range, 150-800 m L）, and 18 days（range, 12-26 days） respectively. No complication of hematoma or wound dehiscence was found. All patients were followed up 17.9 months on average（range, 9-22 months）. No bone graft failure, internal fixation broken, pleural effusion, cerebrospinal fluid leakage, wound infection, fistula formation, and other complications occurred. Satisfactory intervertebral fusion was obtained in all patients at 3-8 months（mean, 5.3 months） after surgery. The ESR, CRP, VAS score, ODI score, and Kyphosis angle were significantly improved at immediate after operation and last follow-up when compared with preoperative ones（P〈0.05）, and the ESR, CRP, VAS score and ODI score at last follow-up were significantly better than those at immediate after operation（P〈0.05）. At last follow-up, the nerve function was recovered to ASIA grade E from grade C（1 case） and grade D（6 cases）. Conclusion Intertransverse bone graft is a reliable, safe, and effective way of bone graft applied to the single segmental thoracic spinal tuberculosis.