单纯后路手术治疗儿童脊柱结核后凸脓肿

One-stage posterior debridement combined with instrumented fusion for thoracolumbar tuberculosis accompanied with kyphosis in children

[目的]评估单纯经后路病灶清除植骨融合内固定术治疗合并椎旁脓肿的儿童脊柱结核胸腰椎后凸畸形的治疗效果。[方法] 2014年1月~2018年2月本院收治合并椎旁脓肿的儿童脊柱结核后凸患儿16例,其中男6例,女10例,年龄3~14岁,平均(7.40±3.67)岁。均采用单纯后路病灶清除矫形植骨融合内固定术治疗,观察比较术前术后及末次随访的局部后凸Cobb角,血沉、C反应蛋白、神经功能评级等指标的变化情况。[结果]所有患儿手术顺利,围手术期无神经损伤或术后瘫痪加重等表现,术后切口均一期愈合。所有病例均获得随访,随访时间12~36个月,平均(21.25±7.65)个月。随访中,ASIA分级由术前B级2例,C级2例,D级12例,改进为未次随访时1例患儿从B级恢复至D级,其余15例患儿恢复至E级,差异有统计学意义(P<0.05)。辅助检查术后3个月ESR和CRP较术前显著降低,差异有统计学意义(P<0.05)。末次随访时影像测量Cobb角较术前显著减少,差异有统计学意义(P<0.05)。至末次随访,未见内固定松动、断裂、脱出等发生,骨性融合良好。[结论]一期后路病灶清除矫形植骨融合内固定术治疗合并椎旁脓肿的小儿胸腰段结核后凸疗效可靠。

[Objective] To explore the efficacy and feasibility of one-stage posterior debridement combined with instrumented fusion for thoracolumbar tuberculosis accompanied with kyphosis in children.[Methods] From January 2014 to February 2018, a total of 16 children who suffered from thoracolumbar tuberculosis accompanied with abscess and kyphosis, including 6 males and 10 females, aged from 3 to 14 years old with an average age of(7.40±3.67) years, were surgically treated with one-stage posterior debridement combined with instrumented fusion. The neurological function, erythrocyte sedimentation rate(ESR), C-reaction protein(CRP), and local kyphotic Cobbs angle measured on X-rays before and after operation were evaluated.[Result] All the children had surgical procedures performed smoothly without nerve injuries or paralysis deterioration in anyone of them, while with primary incision healing in all of them. The children were followed up for 12 to 36 months with an average of(21.25±7.65) months. In term of neurological function, the ASIA grades significantly improved from Grade B in 2, Grade C in 2 and Grade D in 12 cases preoperatively to Grade E in all patients at the latest follow up expect one child who recovered from Grade B to Grade D, which proved statistically significant(P<0.05). The ESR and CRP significantly decreased at 3 months after operation compared with those before operation(P<0.05). In addition, the Cobb angle of kyphosis significantly reduced at the latest follow up compared with that preoperatively(P<0.05). To the latest follow up no loosening or breaking of internal implants was noticed in anyone of them, whereas bony fusion was achieved in all the children.[Conclusion] This one-stage posterior debridement combined with instrumented fusion is effective and reliable for thoracolumbar tuberculosis accompanied with abscess and kyphosis in children.