经肋横突病灶清除固定融合治疗胸椎结核伴后凸畸形

Trans-costotransverse debridement and instrumented fusion for active thoracic spinal tuberculosis accompanied with kyphosis

[目的]总结经肋横突病灶清除植骨融合矫形内固定术治疗活动期胸椎结核伴后凸畸形的疗效。[方法]回顾分析2010年5月~2017年5月采用经肋横突病灶清除固定融合术治疗活动期胸椎结核伴后凸畸形患者。其中符合纳入标准的共76例,男性35例,女性41例;年龄21~74岁,平均(42.62±3.64)岁。胸椎节段性后凸角度为20°~76°。合并脊髓压迫症状者15例。[结果]76例患者均成功完成手术,术中胸膜撕裂5例,2例患者术后发生脑脊液漏,3例术后胸腔积液,经相应处理均未引发不良后果。76例患者随访18~72个月,2例窦道形成、3例切口浅表感染,均经换药等处理后愈合。1例术后18个月时连接棒断裂,行翻修术后治愈。所有患者末次随访时结核治愈,VAS评分较术前显著减小(P<0.05)。15例伴脊髓压迫症状者的ASIA分级由术前B级2例,C级3例,D级10,改进为末次随访时D级2,E级13例,差异有统计学意义(P<0.05)。末次随访时平均后凸Cobb角矫正率(68.36±6.12)%。至末次随访影像学显示所有患者植骨融合良好,结核无复发。后凸畸形矫正角度无明显丢失。术后3个月ESR和CRP均逐渐恢复正常,末次随访ESR和CRP与术前比较差异均有统计学意义(P<0.05)。[结论]经肋横突入路病灶清除植骨融合矫形内固定术治疗3个节段以内的非跳跃性活动期胸椎结核伴后凸畸形,是一种创伤小、疗效满意的手术方式。

[Objective]To summarize the clinical outcomes of trans-costotransverse debridement and instrumented fusion for active thoracic spinal tuberculosis accompanied with kyphotic deformity.[Methods]A retrospective study was conducted on the patients who underwent trans-costotransverse debridement,and instrumented fusion for active thoracic spinal tuberculosis complicated with kyphosis from May 2010 to May 2017.Of them,76 patients met the including criteria were enrolled into this study,consisting of 35 males and 41 females aged 21~74 years with a mean of(42.62±3.64)years.The kyphotic deformity in term of Cobb’s angle ranged from 20 to 76 degree,and the neurological deficits were noticed in 15 patients of them.[Results]All the 76 patients had operation performed smoothly,although intraoperative dural tear in 5,postoperative cerebrospinal fluid leakage in 2 and postoperative pleural effusion in 3 patients were found,which did not lead serious consequences after proper treatments.The 76 patients were followed up for 18~72 months.The fistula in 2 and superficial infection of the incision in 3 patients were noted,which cured well after corresponding treatments such as dressing changes.The link rod breaking happened in1 patient at 18 months postoperatively,which was treated by revision surgery without harmful consequence.To the latest follow up the tuberculotic lesion cured well in all patients,associated with a significant decrease of VAS score compared with that before operation(P<0.05).The ASIA grading significantly upgraded from the Grade B in 2,Grade C in 3 and Grade D in 10 before operation to Grade D in 2 and Grade E in 13 at the latest follow up in the 15 patients who had neurological deficits before operation(P<0.05).Regarding to radiographic assessment,bony fusion achieved in all patients without recurrence of tuberculotic lesion,and the kyphotic deformity was corrected to(68.36±6.12)%to the latest follow up.In addition,the ESR and CRP gradually decreased to the normal levels about 3 months postoperatively,and statistically significant differences were proved in ESR and CRP before operation and at the latest follow up preoperatively(P<0.05).[Conclusion]The trans-costotransverse debridement and instrumented fusion with advantage of minimizing iatrogenic trauma do achieve satisfactory clinical outcomes for thoracic spinal tuberculosis involved less than three segments.