经后路手术治疗上胸段脊柱结核的疗效分析(1)
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[摘要] 目的 探讨经后路病灶清除融合固定术治疗上胸段脊柱结核的临床疗效。方法 回顾性分析2005年6月至2009年4月收治的11例上胸段脊柱结核患者的临床资料。男7例，女4例，平均年龄为43岁(20-67岁)。病变累及单节段者3例，双节段者8例。Frankel分级：B级1例，C级2例，D级5例，E级3例。手术方式为经后路结核病灶清除、植骨融合、椎弓根钉棒系统固定术。11例患者均获得随访，随访时间22-51个月，平均38.3个月。结果 所有患者术中及住院期间无死亡及严重并发症。8例完全治愈，3例症状明显改善。植骨8-12个月均获融合。Frankel分级明显改善，B级0例，C级0例，D级3例，E级8例。结论 经后路病灶清除融合固定术治疗上胸段脊柱结核，手术安全性高，清除病灶彻底，并且能够为脊柱提供足够的稳定性，获得较好的疗效。
[关键词] 上胸段； 脊柱结核； 手术入路
[中图分类号] R681.5[文献标识码] B[文章编号] 1005-0515(2011)-08-001-02
[Abstract] Objective To discuss clinical effect of surgical management of upper thoracic tuberculosis by using debridment, bone grafting and internal fixation throughone stage posterior approach. Methods Retrospective analysis was conducted to analyze the clinical data of 11 patients with upper thoracic tuberculosis ranging in age from 20 to 67 years (average: 43 years). Single vertebrae were damaged in 3 patients, double in 8 patients. Preoperative Frankel grades of these patients were B in 1 cases, C in 2, D in 5 and E in 3. All patients were treated by posterior focus elimination, bone grafting and one-stage posterior transpedicular screw system fixation. 11 patients were followed up for 22 to 51 months postoperatively, with the average of 38.3 months. Results No severe complication occurred during intra-operation and hospitalization. 8 cases were healed and 3 improved significantly.. Spinal fusion occurred 12-18 months after operation. Postoperative frankel grades were B in 0 cases, C in 0, D in 3 and E in 8. Conclusion The segment stability, complete focal cleaning and satisfactory clinical results can be achieved by by using debridment, bone grafting and internal fixation throughone stage posterior approach.
[Key words] Upper thoracic segment； Spinal tuberculosis； Operative approach
上胸段脊柱结核(T1-T4)发病率较低，由于此处的解剖复杂，以往的手术方式多采取单纯脓肿引流或结核病灶清除加外固定，但缺乏有效内固定致脊柱不能获得稳定，病灶难以彻底清除、复发率高，严重影响患者的生活质量[1]。我院自2005年6月至2009年4月收治11例上胸段脊柱结核患者，采取经后路结核病灶清除、植骨融合、椎弓根钉棒系统固定术，疗效满意。现总结如下。
1 资料与方法
1.1 临床资料 本组共11例，男7例，女4例：年龄20-67岁，平均43岁。其中单个椎体破坏3例，两个椎体破坏8例。病程最短2个月，最长15个月，平均4.2个月。神经功能按Frankel分级：B级1例，C级2例，D级5例，E级3例。术前查血沉25-88mm/h，平均46mm/h，X线、CT、MRI等影像学资料表现为椎体骨质破坏、椎间隙变窄、椎旁脓肿形成，后凸成角，相应节段椎管狭窄，硬膜囊受压等，伴有陈旧性肺结核2例。
1.2 手术方法 11例患者均接受手术治疗。麻醉采用气管插管全麻。患者取俯卧位，以病变椎体的棘突为中心作后正中切口 ......
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