上中胸段结核单纯后路病灶清除固定融合

Debridement and instrumented fusion through a mere posterior approach for upper-middle-segment thoracic spine tuberculosis

摘要:

[目的] 探讨上中胸段（T4~6） 结核单纯后路病灶清除固定融合的临床效果。[方法] 回顾性分析2011 年1 月—2016年1 月在本院行上述手术治疗的67 例T4~6 节段结核患者的临床资料，评价临床及辅助检查结果。[结果] 患者均顺利完成手术，手术时间平均（165.1±27.9） min；术中出血量平均（792.5±297.2） ml。67 例患者均获得5 年以上随访，与术前相比，术后1 个月及末次随访时，VAS 评分[(7.1±1.1), (1.7±0.2), (1.3±1.1), P＜0.001]、ODI [(48.9±15.4), (20.2±1.7), (11.2±4.1), P＜0.001] 显著减少；与术前相比，末次随访时ASIA 分级[例, B/C/D/E, (3/5/19/40), (0/2/3/62), P＜0.001] 显著改善。辅助检查方面，与术前相比，术后1 个月及末次随访时，后凸Cobb 角[(34.8±10.9)°, (10.2±1.3)°, (11.3±3.2)°, P＜0.001] 显著减小，ESR [(50.9±16.6) mm/h,(16.9±3.2) mm/h, (10.1±2.4) mm/h, P＜0.001] 和CRP [(34.1±16.7) mg/L, (9.2±2.5) mg/L, (2.6±2.0) mg/L, P＜0.001] 均显著降低。[结论]上中胸段结核单纯后路病灶清除固定融合术能有效清除病灶并纠正后凸畸形，对于T4~6节段结核有良好疗效。

Abstract:

[Objective] To investigate the clinical consequence of debridement and instrumented fusion through a mere posterior ap-proach for upper-middle-segment thoracic spine (T4~6) tuberculosis. [Methods] A retrospective study was conducted on 67 patients whohad T4~6 tuberculosis treated surgically by abovesaid technique in our hospital from January 2011 to January 2016. The clinical and auxilia-ry examination data were evaluated. [Results] All patients had the surgical procedures performed successfully with the average operationtime of (165.1±27.9) min, and average intraoperative blood loss of (792.5±297.2) ml. All of them were followed up for more than 5 years. Astime elapsed from the point before operation, 1 month postoperatively to the latest follow-up, the VAS score [(7.1±1.1), (1.7±0.2), (1.3±1.1),P＜0.001], ODI [(48.9±15.4), (20.2±1.7), (11.2±4.1), P＜0.001] significantly reduced. However, compared with that preoperatively, the ASIAneurological function grade significantly improved at the last follow-up [B/C/D/E, (3/5/19/40), (0/2/3/62), P＜0.001]. As for auxiliary exami-nation, the local kyphotic angle [(34.8±10.9)°, (10.2±1.3)°, (11.3±3.2)°, P＜0.001], ESR [(50.9±16.6) mm/h, (16.9±3.2) mm/h, (10.1±2.4)mm/h, P＜0.001] and CRP [(34.1±16.7) mg/L, (9.2±2.5) mg/L, (2.6±2.0) mg/L, P＜0.001] were significantly decreased over time. [Conclu-sion] The debridement and instrumented fusion through a mere posterior approach do effectively remove the lesions and correct the kyphot-ic deformity, and achieve a satisfactory outcomes for T4~6 tuberculosis.