摘要
目的探讨经前路胸腔一侧一期病灶清除减压植骨融合内固定治疗上胸椎结核的临床疗效。方法 11例上胸椎结核患者,均有不同程度的伴有脊柱后凸畸形,脊柱后凸角为14°～45°,5例合并脊髓损伤,ASIA分级:C级4例,D级1例。术前正规抗痨治疗,并纠正贫血及低蛋白血症。11例患者采用经一侧胸腔前路病灶清除、椎管减压、一期椎体植骨融合术,手术均使用单钉棒系统内固定治疗。术后继续抗痨治疗9～12个月。结果手术时间2.5～5h,平均3h;术中失血量500～1000ml,平均660ml,输血0～600ml,平均375ml。11例患者切口均一期愈合,无肺部感染、呼吸衰竭等并发症。术后随访12～36个月,平均21个月。4例患者在术后4周内瘫痪完全恢复,1例6个月内完全恢复。所有患者血沉均恢复正常,胸背痛消失,植骨骨性融合,融合时间为3～8个月,平均4.9个月,无一例结核复发。术前脊柱后凸Cobb角平均(31.45±8.04)°,术后脊柱后凸Cobb角(14.82±3.25)°,平均矫正约17°。结论采用经胸腔一侧前路一期植骨内固定治疗上胸椎结核手术入路方便、安全,效果好,并发症少,是治疗上胸椎结核有效的治疗方法。
Objective To investigate the effects of surgical management for upper thoracic tuberculosis using focal cleaning, bone grafting and internal fixation through one side of anterior intrapleural approach. Methods 11 cases of upper thoracic tuberculosis were included in the study. The age ranged from 26 to 48 years with an average age of 32.3 years. Clinical features included thoracic and back pain and kyphosis. Kyphosis angle ranged from 14 to 45 degrees. 5 ca- ses were accompanied by spinal cord injury. According to ASIA score system, 4 cases in C grade,and 1 case in D grade. The antituberculous treatment and nutritional supplement were also performed routinely during the perioperative period. Results During the follow-up period of an average 21 months. All of the cases were treated by primary debridement, de- compression, bone graft and internal fixation of single nail-stick system. The operative time was from 2.5h to 5h and the mean operative time was 3 hours. The blood loss was from 500 ml to 1000 ml and the mean blood loss was 660 ml. The mean time in hospital was 10 days and the mean follow-up time was 18 months. The mean blood transfusion was 375 ml. During the follow-up period of an average 21 months, all cases healed without any recurrence and complications such as in- fection, respiratory failure and so on. The thoracic and back pain disappeared and erythrocyte sedimentation rate （ESR） decreased to a normal level. 4 cases of neurological deficits were recovered within 4 weeks, and 1 cases of which recovered at 6 months after operation. Spinal fusion occurred after 3 to 8 months after operation, and seventeen degrees of kyphosis correction was achieved. Conclusion It is a safe and effective method to use focal cleaning, bone grafting and internal fixation through one side of anterior intrapleural approach in the management of upper thoracic tuberculosis.
出处
《西部医学》
2012年第11期2176-2178,共3页
Medical Journal of West China
关键词
胸椎结核
前路
病灶清除
植骨
内固定
Thoracic vertebrae
Anterior approach
Focal cleaning
Internal fixation
