| 罗 伟,李 康,许少策,王诗尧,汪玉良.梯形切口一期前外侧经肋横突入路手术治疗胸椎结核的临床研究[J].中国脊柱脊髓杂志,2017,(10):889-896. |
| 梯形切口一期前外侧经肋横突入路手术治疗胸椎结核的临床研究 |
| 中文关键词: 胸椎结核 梯形切口 手术治疗 |
| 中文摘要: |
| 【摘要】 目的：观察梯形切口一期前外侧经肋骨横突入路手术治疗胸椎结核的临床疗效。方法：回顾性分析2013年9月～2016年3月我科收治的胸椎结核患者25例，其中男13例，女12例，年龄19～67（42.2±14.8）岁。病变节段位于T5~T12，伴有后凸畸形12例，Cobb角23.5°～40.2°，平均28.8°±4.8°；脊髓损伤Frankel分级：C级3例，D级20例，E级2例。入院时血沉28.1±21.7mm/h。术前VAS评分6.4±1.1分。均采用梯形切口一期后路椎弓根内固定，联合前外侧肋骨横突切除胸膜外入路清除病灶植骨融合。术后根据细菌培养和药敏试验结果进行抗结核药物治疗，持续9～24个月，平均15.6±5.5个月。记录手术时间、出血量、输血量、手术入路相关并发症，比较术前与术后3个月视觉疼痛模拟评分（VAS）、红细胞沉降率（ESR）、神经功能Frankel分级。术后6个月采用Kirkaldy-Willis功能评分评价患者术后神经功能恢复情况。比较患者术前与术后3d、术后3d与术后9个月Cobb角。结果：25例患者均顺利完成手术，手术时间4.3～6.2（5.2±0.5）h；术中出血量440～650（552.2±62.7）ml。25例患者术后均获随访，随访12～34（22.1±6.8）个月。术前血沉9.6±4.3mm/h，术后3个月血沉6.8±2.8mm/h，VAS评分3.5±1.1分，均较术前显著降低（P<0.05）。12例伴有后凸畸形的患者术后3dCobb角为21.7°±5.6°，术后9个月Cobb角为22.4°±5.6°，平均角度丢失为0.6°±0.4°。术前与术后3d的Cobb角相比差异有统计学意义（P<0.05）。椎间植骨融合时间6～9（7.0±0.9）个月。随访患者中无内固定松动、脊柱失稳、脊髓损伤加重、结核复发等并发症。3例Frankel分级为C级的患者，术后3个月随访时2例恢复至D级，1例恢复至E级。20例Frankel分级为D级的患者，术后3个月均恢复至E级。术后3个月神经功能分级与术前相比较差异具有统计学意义（P<0.05）。Kirkaldy-Willis功能评分优良率为96%。结论：采用梯形切口一期前外侧经肋横突入路手术配合术后积极化学治疗可显著改善患者神经功能和矫正后凸畸形，获得满意的疗效。 |
Clinical research on the treatment of thoracic vertebral tuberculosis by one-stage anterolateral costotransverse extrapleural approach |
| 英文关键词:Thoracic vertebral Tuberculosis Trapezoid Shape incision Surgical treatment |
| 英文摘要: |
| 【Abstract】 Objectives: To evaluate the clinical effect of one-stage posterior instrumentation combined with anterolateral costotransverse extrapleural debridement and bone graft for the treatment of thoracic tuberculosis by means of trapezoid shape incision. Methods: From September 2013 to March 2016, a total of 25 patients with thoracic tuberculosis were admitted to our department. Among the 25 cases, there were 13 males and 12 females. The average age was 42.2±14.8 years(range, 19-67). The levels of lesions were T5-T12. There were 12 cases complicated with kyphosis. The average kyphosis angle was 28.8°±4.8°(range, 23.5°-40.2°). According to Frankel grade of neurological deficit, 3 cases were graded as grade C, 20 cases were grade D and 2 cases were grade E. At the time of admission, ESR was 28.1±21.7mm/h. The preoperative VAS score was 6.4±1.1. All 25 cases underwent trapezoid shape incision and one-stage posterior instrumentation combined with anterolateral costotransverse extrapleural debridement and bone graft. Regular and effective anti-tuberculosis medicine treatment was lasted for 9-24 months on the basis of bacterial culturing and drug sensitive test, with an average of 15.6±5.5 months. The operation time, the amount of bleeding during operation, intraoperative and postoperative blood transfusion, major complications associated with approach were recorded. Visual analogue scale(VAS), ESR, Frankel neural function classification were assessed before and after surgery. The recovery of neurological function was evaluated by Kirkaldy-Willis functional score at 6 months postoperatively. The Cobb angle at preoperation was compared with that at 3 days and 9 months after surgery. Results: All surgeries were successfully completed, the average operation time was 5.2±0.5h(range, 4.3-6.2h). The amount of intraoperative blood loss was 440-650ml, the average was 552.2±62.7ml. 25 patients were followed up from 12 to 34 months, with an average follow-up of 22.1±6.8 months. Preoperative ESR was 9.6±4.3mm/h and ESR at 3 months after operation was 6.8±2.8mm/h. The VAS score was 3.5±1.1 at 3 months after operation． The mean VAS scores and ESR were significantly lower than those before operation(P<0.05). The postoperative Cobb angle for 12 patients with kyphosis was 21.7°±5.6° and 22.4°±5.6° at 9 months after operation. The average angle loss was 0.6°±0.4°. There was significant difference between preoperative and postoperative Cobb angle(P<0.05). The period of interbody fusion was from 6 to 9 months, the average was 7.0±0.9 months. There were no complications during follow-up, such as loosening of internal fixation, spine instability, the aggravation of neurological deficit and so on. Among 3 patients with Frankel grade C, 2 cases recovered to grade D at 3 months after operation, and 1 case recovered to grade E. 20 patients with Frankel grade D recovered to grade E at 3 months after operation, which showed a significant difference when compared with preoperative ones(P<0.05). The Kirkaldy-Willis function score showed that the total fine rate was 96%. Conclusions: Trapezoid shape incision and one-stage posterior instrumentation combined with anterolateral costotransverse extrapleural debridement and bone graft, along with postoperative active chemotherapy is proved to be successful in treating thoracic vertebral tuberculosiscan as it improves the neurological function and kyphosis correct. |
| 投稿时间：2017-06-23 修订日期：2017-09-14 |
| DOI： |
| 基金项目: |
|
| 摘要点击次数: 1672 |
| 全文下载次数: 1104 |
| 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
