摘要
目的探讨数字技术支撑胸腔镜下胸椎结核病灶清除植骨内固定的治疗效果及安全性。 方法回顾分析2010年6月－2012年2月收治的符合选择标准的11例胸椎结核患者临床资料，其中男7例，女4例；年龄16～47岁，平均23.6岁。病程6～18个月，平均16个月。术前影像学检查示均为T6～11胸椎结核，破坏累及2个椎体和1个椎间隙。术前神经功能Frankel分级均为E级。将患者胸廓脊柱三维CT数据输入SUPERIMAGE工作站建立个体化胸廓、脊柱模型，选择合理工作通道、设定各通道作用（清除病灶、植骨、植钉），建立手术预案。按术前设计完成通道的建立、病灶暴露、清除、植骨、内固定。 结果患者术中操作均与术前设计相符，均通过预定通道应用胸腔镜完成结核病灶清除、植骨、内固定等操作。手术时间120～180 min，平均146 min；出血量100～150 mL，平均120 mL；术后胸腔闭式引流留置时间24～48 h，平均38 h；住院时间3～5 d，平均4.6 d。11例均获随访，随访时间12～25个月，平均16个月。术后神经功能Frankel分级均为E级。无切口疼痛、肺部及切口感染。末次随访时X线片及三维CT示植骨块位置良好，部分区域已融合，胸椎后凸无变化，内固定无失败。 结论在数字技术支撑胸腔镜下治疗胸椎结核，可达到微创、高效、安全的治疗效果。
Objective To explore the effectiveness and safety of treatment of thoracic tuberculosis with thoracoscope supported by digital technology. Methods Between June 2010 and February 2012, 11 patients with thoracic tuberculosis were treated and the clinical data were retrospectively analyzed. There were 7 males and 4 females with an average age of 23.6 years （range, 16-47 years） and an average disease duration of 16 months （range, 6-18 months）. Two vertebral bodies and one intervertebral space were involved at T6-11. At preoperation, the neurologic function degree was classified as Frankel grade E. Three dimensional reconstruction of thorax and spine and surgical procedure design （including focal clearance, bone grafting, and screw fixation） were done at SUPERIMAGE workstation. Surgery procedures were conducted following the preoperative designs. Results The operative procedures were consistent with preoperative designs. All of these operations were successfully performed. The mean time of operation was 146 minutes （range, 120-180 minutes）; the mean blood loss was 120 mL （range, 100-150 mL）; the mean indwelling time of closed thoracic drainage was 38 hours （range, 24-48 hours）; and the mean hospitalization time was 4.6 days （range, 3-5 days）. Eleven patients were followed up 12-25 months （mean, 16 months）. No complication of nerve damage, incision pain and infection, or pulmonary infection was observed. Rigid fixation and born fusion were obtained at last follow-up; no obvious change of thoracic vertebral alignment was detected and no internal fixation failure occurred. Conclusion It is a minimally invasive, effective, and safe method to treat thoracic tuberculosis with thoracoscope supported by digital technology.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第1期64-68,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胸腔镜
胸椎结核
数字技术
病灶清除
内固定
Thoracoscope Thoracic tuberculosis Digital technology Debridement Internal fixation
