Ⅰ期前路病灶清除、取自体肋骨植骨、后路钉棒系统内固定术治疗胸椎结核临床效果观察

Clinical effect of I stage anterior debridement,rib autograft and posterior internal fixation in the treatment of thoracic tuberculosis

目的观察Ⅰ期前路病灶清除、取自体肋骨植骨、后路钉棒系统内固定术治疗胸椎结核的临床效果。方法回顾性分析北部战区总医院和解放军总医院第八医学中心自2009年1月1日至2018年10月31日收治的接受Ⅰ期前路病灶清除、取自体肋骨植骨、后路钉棒系统内固定术治疗且获得满意随访的30例胸椎结核患者的临床资料。记录患者的手术时间、出血和输血量、术后并发症发生和骨愈合情况;比较术前、术后的后凸Cobb角、血沉和C-反应蛋白水平,以及Frankel分级变化,并计算改善率。结果 30例患者手术过程顺利,平均手术时间(4.45±0.35)h,平均出血(750.00±130.00)ml,术后输血(450.00±100.00)ml,术后均恢复良好,未发生严重并发症。平均随访17.3个月。随访结束时,30例患者取肋骨植骨效果满意,均达到骨性愈合,最长愈合时间为12个月,且均无结核复发。患者术前Frankel分级A级7例、B级6例、C级8例、D级6例,末次随访Frankel分级B级5例、C级4例、D级8例、E级10例,改善率为92.6%(25/27)。患者术前平均血沉(83.2±20.9)mm/h,平均C-反应蛋白(87.1±17.0)mg/L;术后2周,平均血沉(36.9±9.9)mm/h,平均C-反应蛋白(35.4±8.3)mg/L。患者术后2周平均血沉和C-反应蛋白水平均低于术前,差异有统计学意义(P<0.05)。患者术前、术后1周、末次随访时的平均后凸Cobb角分别为(64.2°±19.2°)、(24.9°±4.2°)、(26.6°±3.8°),术后1周平均后凸Cobb角小于术前,差异有统计学意义(P<0.05),术后1周与末次随访时的平均后凸Cobb角比较,差异无统计学意义(P>0.05)。结论Ⅰ期前路病灶清除、取自体肋骨植骨、后路钉棒系统内固定术治疗胸椎结核安全有效,可纠正脊柱生理曲度畸形,重建并恢复脊椎稳定,彻底刮除病灶,解除脊髓及神经根的压迫症状,促进脊神经功能恢复。

Objective To observe the clinical effect of I stage anterior debridement,rib autograft and posterior internal fixation in the treatment of thoracic tuberculosis.Methods A retrospective study was performed on 30 cases of patients with thoracic tuberculosis who were admitted and underwent I stage anterior debridement,rib autograft and posterior internal fixation from January 1 st,2009 to October 31 st,2018.The operation time,bleeding and blood transfusion volume,postoperative complications and bone healing were recorded;the preoperative and postoperative kyphosis Cobb angle,erythrocyte sedimentation rate(ESR),C-reactive protein level,and Frankel grading changes were compared,and the improvement rate was calculated.Results The operation of the 30 patients was smooth,the average operation time was(4.45±0.35)hours,the average bleeding was(750.00±130.00)ml,and the postoperative blood transfusion was(450.00±100.00)ml.All patients recovered well after the operation without serious complications,and the mean follow-up was 17.3 months.At the end of follow-up,rib graft was taken from 30 patients with satisfactory results,all of them achieved osseous healing,and the longest healing time was 12 months,and none of them had tuberculosis recurrence.Preoperative Frankel classification included 7 cases of Grade A,6 cases of Grade B,8 cases of Grade C and 6 cases of Grade D.In the last follow-up,Frankel classification included 5 cases of Grade B,4 cases of Grade C,8 cases of Grade D and 10 cases of Grade E,and the improvement rate was 92.6%(25/27).The mean ESR was(83.2±20.9)mm/hour and C-reactive protein was(87.1±17.0)mg/L before operation;2 weeks after operation,the mean ESR was(36.9±9.9)mm/hour and C-reactive protein was(35.4 ± 8.3)mg/L.The average ESR and C-reactive protein levels at 2 weeks after operation were lower than those before operation,and the difference was statistically significant(P<0.05).The mean kyphosis Cobb angle was(64.2°±19.2°),(24.9°±4.2°)and(26.6°±3.8°)before surgery,1 week after surgery and at the last follow-up,respectively.The mean kyphosis Cobb angle at 1 week after surgery was smaller than that before surgery(P<0.05).The difference between the mean kyphosis Cobb angle at 1 week after surgery and at the last follow-up was not statistically significant(P>0.05).Conclusion I stage anterior debridement,autogenous rib graft and posterior screw rod system internal fixation are safe and effective in the treatment of thoracic tuberculosis,which can correct the deformity of spinal physiological curvature,reconstruct and restore the stability of the spine,completely scrape the lesions,relieve the compression symptoms of spinal cord and nerve root,and promote the recovery of spinal nerve function.