腋下切口病灶清除肋骨植骨单钉棒内固定治疗胸椎结核

Transaxillary thoracotomy for debridement combined with instrumented fusion by rib autograft and unilateral screw-rod system in treatment of thoracic tuberculosis

[目的]探讨腋下小切口经胸入路病灶清除肋骨捆绑植骨单钉棒内固定治疗胸椎结核的临床疗效。[方法]回顾性分析青岛市胸科医院外科2008年1月~2015年1月收治的胸椎结核患者41例,男22例,女19例;年龄9~73岁,平均(50.60±11.31)岁。采用腋下微创剖胸入路病灶清除脊髓减压取肋骨捆绑植骨单钉棒内固定手术治疗,观察术后恢复情况(Frankel分级、Cobb角、ESR、CRP、VAS评分)。[结果]41例患者手术时间平均为(170±53)min,术中出血量平均为(860±155)ml。随访时间12~48个月,平均34个月。所有病例均无局部结核复发,达到骨性融合,未出现植骨块吸收、骨折、断钉、断棒的情况。末次随访时Frankel分级由术前A级2例、B级10例、C级11例、D级11例、E级7例,恢复至D级2例、E级39例(P<0.05)。VAS评分由术前(7.72±1.13)分减少至末次随访时(1.72±0.24)分,差异有统计学意义(F=11.325,P=0.037)。Cobb角由术前(20.73±4.65)°显著减少至末次随访时(5.35±2.16)°,差异有统计学意义(F=14.843,P=0.008)。[结论]采用腋下切口经胸入路病灶清除肋骨捆绑植骨单钉棒内固定治疗胸椎结核伴瘫痪创伤小,疗效满意。

[Objective] To evaluate the clinical outcome of transaxillary thoracotomy for debridement combined with instru- mented fusion with rib autograft and unilateral screw-rod system in treatment of thoracic tuberculosis. [Methods] This retro- spective study was conducted on the clinical data of 41 patients with thoracic tuberculosis, including 22 males and 19 females aged from 9 to 73 years with an average of （50.6±11.3） years. All the patients underwent transaxillary minithoraeotoy for debride- ment combined with binded rib autografts and unilateral screw-rod fixation from January 2008 to January 2015 in our depart- ment. Frankel grade, Cobb angle, ESR, CRP and VAS were used for evaluation of the consequence. [Results] The surgery lasted for （170_＋53） rain with blood loss of （860±155） ml on average in the 41 patients. The patients were followed up for 12 to 48 months with an average of 34 months. Solid bony fusion without recurrence of tuberculosis was gotten in all the patients, corre- spondingly, no absorption of bone graft, rupture or loosening of instruments was noted in any of them. The Frankel grade signifi- cantly upgraded from Grade A in 2 patients, Grade B in 10, Grade C in 11, Grade D in 11 and Grade E in 7 preoperatively to Grade D in 2 and Grade E grade in 39 patients at the final follow-up. In addition, VAS considerably decreased from （7.72±1.13） preoperatively to （1.72±0.24） （F=1.325, P=0.037） at the latest follow up, likewise, Cobb angle of kyphosis significantly re- duced from （20.73±4.65） ° to （5.35±2.16）° （F= 14.843, P=0.008）. [Conclusion] Transaxillary minithoracotomy for debridement combined with instrumented fusion with rib autograft and unilateral serew-rod system in treatment of thoracic tuberculosis doeshave satisfactory results, associated with advantages of mini- mizing surgical trauma and facilitating recovery of neurolog- ic function.