后路椎板减压病灶清除钛网植骨内固定术治疗胸椎结核

Posterior decompression, debridement, bone grafting and internal fixation for thoracic spinal tuberculosis

目的探讨后路椎板减压病灶清除钛网植骨内固定术治疗胸椎结核的安全性及有效性。方法回顾性分析2013年10月—2015年7月采用后路椎板减压病灶清除钛网植骨内固定术治疗的28例胸椎结核患者资料。记录手术时间、术中出血量,比较术前、术后1周和末次随访时患者胸腰背部疼痛视觉模拟量表(VAS)评分、胸椎后凸Cobb角、脊柱矢状面偏移(SVA)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、红细胞沉降率(ESR)、C反应蛋白(CRP),观察神经功能改善情况、植骨融合情况及并发症发生情况。结果所有患者均得到随访,随访(20.3±4.4)个月,手术时间(194.1±27.3)min,术中出血量(921.4±199.3)m L。术后患者胸腰背部疼痛VAS评分、胸椎后凸Cobb角、SVA、PT、SS、ESR、CRP均较术前明显改善,差异有统计学意义(P<0.05)。术后大部分患者神经功能得到明显改善,植骨融合率达100%,所有患者均无结核复发、均未发生严重并发症。结论后路椎板减压病灶清除钛网植骨内固定术治疗胸椎结核安全、有效。

Objective To evaluate the safety and efficacy of posterior decompression,debridement,bone grafting with titanium mesh and internal fixation in the treatment of thoracic spinal tuberculosis.Methods The clinical data of 28 patients with thoracic spinal tuberculosis treated by posterior decompression,debridement,bone grafting with titanium mesh and internal fixation between October 2013 and July 2015 were retrospectively analyzed.The operation time and the blood loss during operation were recorded.The visual analogue scale(VAS)score of back pain,the Cobb’s angle of thoracic kyphosis,the sagittal vertical axis of the spine(SVA),the pelvic incidence(PI),the pelvic tilt(PT),the sacral slope(SS),the level of erythrocyte sedimentation(ESR)and C-reactive protein(CRP)were compared between pre-operation and post-operation.The improvement of neurological function,bone graft fusion and complications were observed.Results All the patients were followed up.The follow-up period was(20.3±4.4)months,the operation time(194.1±27.3)min,and the blood loss(921.4±199.3)mL.There were significant improvements at post-operation in the VAS score of back pain,the Cobb’s angle of thoracic kyphosis,SVA,PT,SS,the level of ESR and CRP(P<0.05).The postoperative nerve function was improved significantly,and the bone fusion rate reached 100%.All the patients had no serious complication and no recurrence of tuberculosis.Conclusion Posterior decompression,debridement,bone grafting with titanium mesh and internal fixation is a relatively safe and effective method for the treatment of thoracic tuberculosis.