经肋横突关节入路一期病灶清除融合固定治疗单节段上胸椎结核

Single-stage Costotransverse Joints Approach Debridement,Titanium-mesh Bone Grafting and Transpedicular Screw Fixation for the Treatment of Mono-segmental Upper Thoracic Spinal Tuberculosis

目的:探讨后路经肋横突关节入路一期病灶清除、钛网植骨椎间融合、椎弓根钉棒内固定治疗单节段上胸椎结核的临床疗效。方法:本院采用该手术入路方法治疗的单节段上胸椎结核患者共32例,术前均行四联抗结核治疗,根据Frankel分级,B级2例,C级8例,D级12例,E级10例。分析术前、术后3个月及末次随访Cobb’s角、VAS评分、ESR、CRP及Frankel分级情况,评估融合情况及手术并发症。结果:所有患者均得到随访,平均随访时间16.5个月,平均手术时间(118.6±32.6)min,出血量(653.6±158.2)m L。术前上胸椎Cobb’s角平均(32.4±7.6)°,术后矫正至(15.1±5.7)°,末次随访为(16.2±2.2)°,术后矫正的上胸椎Cobb’s角与术前比较差异有统计学意义(P<0.05),与末次随访比较差异无统计学意义(P>0.05)。术前ESR平均(68.4±17.6)mm/h,术后3个月下降至(15.4±6.7)mm/h,与术前比较差异有统计学意义(P<0.05),末次随访全部恢复正常(9.6±3.4)mm/h,与术前和术后3个月比较差异均有统计学意义(P<0.05)。Frankel分级:B级2例,改善至C级1例,1例无改善;C级8例,改善至D级6例、2例无改善;D级12例,全部改善至E级。末次随访椎间植骨全部融合。术后无严重的并发症,1例伤口愈合差、2例术后出现血气胸,2例出现脑脊液漏,均经治疗后恢复。结论:经肋横突关节入路一期病灶清除、钛网植骨融合、椎弓根钉棒内固定治疗单节段上胸椎结核,临床效果良好,是有效可行的手术方案。

Objective：To explore the clinical value of single-stage costotransverse joints approach debridement,titanium-mesh bone grafting and transpedicular screw fixation for the treatment of mono-segmental upper thoracic spinal tuberculosis.Method：32 cases with mono-segmental upper thoracic spinal tuberculosis who had been treated in our hospital.All patients received standard HREZ chemotherapy prior to surgery.Frankel grading preoperative was grade B of 2 cases,grade C of 8 cases,grade D of 12 cases and grade E of 10 cases.Cobb’s angle,VAS scores,ESR,CRP and Frankel grading were collected at preoperation,3 months postoperation and final follow-up to evaluate bone fusion and operative complications.Result： All patients were followed up for average 16.5 months.The mean operative time of patients with costotransverse joints approach surgery was （118.6±32.6）min, and the mean blood loss was （653.6±158.2）mL.The average preoperative Cobb’s angle was （32.4±7.6）°,which decreased to （15.1±5.7）° postoperatively,with a degree of （16.2±2.2）° by the last visit.Postoperative Cobb’s angle had significant difference when compared with Preoperative Cobb’s angle（P〈0.05）,whereas had no obvious difference when compared with Cobb’s angle of last follow-up（P〉0.05）.The average preoperative ESR was （68.4±17.6）mm/h,which decreased to （15.4±6.7）mm/h 3 months postoperatively, there was significant difference between preoperative and postoperative ESR（P〈0.05）.At last follow-up, the average ESR got normal （9.6±3.4）mm/h in all patients.The last follow-up ESR had significant difference when compared with preoperative or 3 months postoperative ESR （P〈0.05）.Frankel grading preoperatively was grade B of 2 cases, which improved to grade C of 1 case;grade C of 8 cases, which improved to grade D of 6 cases;grade D of 12 cases,which all patients improved to grade E at the last follow-up.Solid fusions were obtained in all followed-up cases.No serious complications were observed,1 case had poor wound healing,and 2 cases suffered hemopneumothorax,which finally recovered after treatment.Conclusion：Single-stage costotransverse joints approach debridement,titaniummesh bone grafting and transpedicular screw fixation is an efficacy and safety treatment for mono-segmental upper thoracic spinal tuberculosis.