内镜配合下经椎弓根通道治疗胸腰椎结核的可行性研究

Feasibility study of endoscope with pedicle channel for the treatment of thoracolumbar spinal tuberculosis

目的:探讨内镜配合下经椎弓根通道治疗胸腰椎结核的可行性。方法:调取影像报告阴性的胸椎及腰椎CT片各50例,测量椎弓根的内横径、内纵径、内切角及椎体的下倾角,并对5具人体标本及65块(T5~L5)人椎体干标本行模拟操作,初步验证内窥镜配合下经椎弓根通道治疗胸腰椎结核术式的可行性;结果:(1)除L5外,椎弓根的内横径!内纵径,内横径是决定器械顺利操作的最关键参数,内切角及下倾角对手术操作有指导作用。(2)胸腰椎体干标本与人体标本模拟手术操作结果相近,除少部分中胸椎需要咬除椎弓根外侧骨皮质,其余均可在保持椎弓根骨皮质完整的情况下通过椎弓根通道完成病灶清除,术毕脊髓及神经根无损伤。结论:椎弓根通道由于有骨皮质间隔开脊髓及神经根是一个较安全的通道,配合内镜在可视情况下可完成结核病灶清除,提高了病灶清除效果及手术安全性,此手术途径切实可行。

Objective： To explore the feasibility of endoscopic with pedicle channel for the treatment of thoracolumbar spinal tuberculosis. Methods： Data were obtained from the respective 50 patients reported negative of thoracic and another 50 cases of lumbar CT. The pedicle of the inner diameter,inner longitudinal diameter,inscribed angle and inclination angle of the vertebral body of the patients were measured. Simulated operation were conducted in 5 human＇s spines with total 65 pieces of vertebrae dry specimens（ T5~ L5）,and the feasibility of endoscopic with pedicle channel for the treatment of thoracolumbar spinal tuberculosis was verified. Results：（1） Except for L5,the inner diameter of the pedicle was less than the longitudinal diameter,and the inner diameter of the pedicle was the most critical parameter of the smooth operation of the instrument,and the cutting angle and the angle of operation played a guiding role.（2） The simulated operation of thoracolumbar dried specimens and human specimens was similar,except for a small portion of the lower thoracic pedicle needed to bite than the outer bone,and the rest,under the circumstances of maintaining a complete cortical bone of the pedicle,could be found to clean up the lesions through the the completion of the pedicle channel. After operation,the spinal cord and nerve roots were found to be with no injuries. Conclusion： The pedicle channel is a safe channel,and together with the visual endoscope,tuberculosis focus can be completely debrided. It will be practical and feasible to improve the removal effect of tuberculosisfocus and operation safety.