个体化术式治疗多节段及跳跃性胸腰椎结核

Individualized surgical treatment for multi-vertebral or noncontiguous thoracolumbar tuberculosis

[目的]探讨不同术式治疗多节段及跳跃性胸腰椎结核的疗效。[方法]2008年5月~2015年3月,本科共收住25例患者,男17例,女8例,年龄11~59岁,平均27岁。术前常规摄全脊柱正侧位X线片、CT平扫加3D重建和MRI。病变节段:胸椎11例,胸腰段9例,腰椎5例,累及4个椎体10例,5个椎体7例,6个椎体5例,7个椎体3例。手术方式:7例行开胸"前路"手术,4例行开胸"前后"入路手术,9例行胸膜外腹膜后"前后"入路手术,5例行腹膜外"前后"入路手术。出院后正规抗结核治疗6~12个月,定期随访观察植骨融合时间,后凸畸形矫正度、椎间隙高度和神经功能恢复程度,血沉、C反应蛋白变化情况。[结果]本组患者均顺利接受手术,无严重并发症。至术后第3 d,后凸畸形平均纠正至27°,与术前相比差异有统计学意义(P<0.05)。椎间隙高度平均增加4.2 mm,与术前相比差异有统计学意义(P<0.05)。术后1周,ESR和CRP分别下降至15 mm/h,16mg/L,其变化均具有统计学意义(P<0.05),至术后3个月,所有合并脊髓神经损伤患者神经功能均恢复至E级。所有病例均得到随访,随访时间1~3.5年,平均植骨融合时间为7个月,融合率100%。至末次随访,所有患者ESR和CRP在正常范围内,且均无明显波动,无矫形角度丢失。[结论]个体化选择前路或前后联合的术式不仅可以根治结核,同时可以恢复胸腰椎正常生理曲度,重建脊柱稳定性,使患者回归正常生活。

[Objective] To evaluate the clinical outcome of individualized surgical treatment for multi-vertebral or non- contiguous thoracic and/or lumbar spinal tuberculosis. [Method] A total of 25 patients with thoracic and/or lumbar spinal tu- berculosis were treated surgically from 2008 to 2015, including t7 males and 8 females with an average age of 27 years ranged from 11 to 59 years. Tuberculosis lesion were located at thoracic in 11 cases, thoracolumbar segments in 9 cases, as well as Iron- bar in 5 cases. Surgical debridement and internal fixation were carried out through thoracic anterior approach in 7 cases, thorac- ic anteroposterior approach in 4 cases, extrapleural retroperitoneal anteroposterior approach in 9 cases, and retroperitoneal anteroposterior approach in 5 cases. After surgery, the anti-tuberculosis drugs were given to all patients for at least 12 months. The implantation fusion time, kyphosis deformity correction degree, the change of intervertebral height, the neurological functiunal recovery, ESR, CRP were observed and recorded. [Result] All patients had successful operations without serious opera- live complication. At 3 days postoperatively, the kyphosis deformity was corrected by an average of 27°, with a significant difference （P 〈 0.05） , additionally the interverbral space height increased by a mean of 4.2 mm with a signifcant difference compared with that before operation （P 〈 0.05） . At 1 week after operation, the ESR and CRP signifcantly decreased to 15 mm / h and 16 mg/L respectively （P 〈 0.05） . All patients were followed up for 1-3.5 years. The lesions got solid fusion in an average of 7 months, with 100% fusion rate. No recurrence or serious complication was found during the follow up period. [ Conclusion] The individualized surgical treatment not only cure the TB, but also rectify the spine deformity and rebuild the stability, which can lead the patients back to the normal life as soon as possible.