儿童胸腰椎结核性后弯畸形的临床评估及术式选择

目的 探讨如何根据儿童胸腰椎结核性后弯畸形的临床及影像特征,选择手术方式,防止后弯畸形进展及降低神经并发症发生率.方法 本组14例,男3例,女11例,年龄4～18岁,平均11.8岁.其中活动性结核性后弯畸形6例;静止性结核性后弯畸形8例.活动性结核性后弯畸形(6例)的手术方法 :①前路病灶清除、植骨融合术3例;②Ⅰ期后路经椎弓根椎体截骨矫形融合、Ⅱ期前路病灶清除植骨融合术3例.静止性结核性后弯畸形(8例)的手术方法 :①后路原位融合术3例;②后路全脊椎截骨矫形内固定融合术2例;③Ⅰ期后路经椎弓根椎体截骨矫形内固定融合术、Ⅱ期前路支撑融合3例.影像测量:在术前、术后及末次随访侧位X线片上测量后弯角(K)、畸形角(D).结果随访6～48个月,平均25个月.活动性结核患儿无结核复发、窦道形成及切口感染,无神经并发症.6例活动性结核性,后弯角(K)术前平均46°,术后平均20°,末次随访平均22°;畸形角(D)术前平均47°,术后平均25°,末次随访平均27°.8例静止性结核性后弯,后弯角(K)术前平均50°,术后平均44°,末次随访平均47°;畸形角(D)术前平均42°,术后平均34°,末次随访平均36°.结论 儿童胸腰椎结核性后弯畸形的术式选择应根据其自然史特征、病变累及范围及后弯畸形的病理阶段,采用个体化的手术策略,可以取得满意的疗效.

Clinical evaluation and surgical treatment of thoracolumbar kyphosis secondary to childhood spinal tuberculosis

Objective To discuss the surgical strategy and efficacy for thoracolumbar kyphosis secondary to spinal tuberculosis (TB) in children. Methods Fourteen patients were enrolled in this study,including 11 females and 3 males with an average age of 11.8 years (range,4 to 18 years). Thoracolumbar kyphosis was present in all patients. Six patients were diagnosed with active spinal TB and the other 8 with healed spinal TB. In the 6 patients with active TB,3 patients were treated by sin-gle-stage anterior spinal debridement and fusion; and the other 3 underwent two-stage corrective oper-ations,by which posterior transpedicular osteotomy was performed in the first stage,and anterior de-bridement and strut graft fusion was performed in the second stage 2 weeks later. In the 8 patients with healed TB,3 patients underwent single-stage posterior in situ spinal fusion; 2 underwent single-stage posterior tranpedicular osteotomy; and the other 3 patients were performed with posterior total vertebrae resection in first stage,and anterior strut graft spinal fusion in second stage 2 weeks later. The kyphos and deformity angles were measured preoperatively and postoperatively on the lateral spi-nal radiographs,and were followed up after patients were discharged. Results All the patients were followed up,with a mean follow-up period of 25 months (range,6 to 48 months). No TB lesion re-currence,sinus tract,infection or neurological deficit was noted. In the 6 patients with active spinal TB. In the 6 patients with active spinal TB,the mean kyphosis was 46° before surgery,it was correc-ted to 20° after surgery,and 22° at final follow-up; the mean deformity angle was 47°,it was improved to 25° after surgery,and 27° at final follo'w-up. In the 8 patients with healed spinal TB,the mean ky-phosis was 50° before surgery,it was corrected to 44° after surgery,and 47° at final follow-up; the mean deformity angle was 42°,it was improved to 34° after surgery,and 36° at final follow-up. Con-clusions To achieve good clinical outcomes,the option for surgical strategy for thoracolumar kyphosis caused by TB in children should be based on patients' radiographic and clinical fea-tures.