椎旁肌间隙入路经关节突病灶清除椎体间植骨融合治疗胸椎结核

目的 探讨椎旁肌间隙入路经关节突病灶清除、椎体间植骨融合内固定治疗胸椎结核的可行性及临床疗效.方法 回顾性分析我院于2012年6月至2014年8月应用椎旁肌间隙入路经关节突病灶清除、椎体间植骨融合内固定治疗的单节段胸椎结核病人25例,其中男11例,女14例;年龄为21~63岁,平均为39.5岁.其中T4/54例,T5/61例,T7/83例,T8/94例,T9/105例,T10/113例,T11/125例.X线片显示病人均有不同程度的脊椎局部后凸畸形,CT及MRI显示所有病灶均有不同程度骨质破坏及脓肿形成.术前美国脊柱损伤协会(American Spinal Injury Association,ASIA)脊髓损伤功能分级:D级5例,E级20例.记录并评价病人手术时间、术中出血量、术后并发症、神经功能恢复情况及植骨融合情况.结果 所有病人手术均顺利完成,手术无严重并发症发生,平均手术时间为210 min,平均失血量为900 ml.病人均获得随访,随访时间为12~30个月,平均为20个月.术后3个月内红细胞沉降率(erythrocyte sedimenta-tion rate,ESR)及C反应蛋白(C-reactive protein,CRP)恢复至正常水平.末次随访时植骨融合良好,融合率100%.末次随访神经功能均得到改善.结论 椎旁肌间隙入路经关节突病灶清除、椎体间植骨融合内固定治疗胸椎结核具有疗效确切、创伤小及并发症较少的优点,是治疗胸椎结核的有效方法.

Clinical study of transfacet debridement combined with bone grafting and internal fixation in treatment of thoracic tuberculosis via thoracic paraspinal approach

Objective To evaluate the clinical feasibility and efficacy of transfacet debridement com-bined with bone grafting and internal fixation in treatment of thoracic tuberculosis via paraspinal approach. Methods From June 2012 to August 2014, 25 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 14 females with age ranging from 21 to 63 years (average, 39.5). There were 4 patients in T4/5, 1 patient in T5/6, 3 patients in T7/8, 4 patients in T8/9, 5 patients in T9/10, 3 patients in T10/11, and 5 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. For the classification of American Spinal Injury Association (ASIA), there were 5 cases of grade D and 20 cases of grade E. The operation time, blood loss, postoperative complications, the situation of neurological recovery and bony fusion were recorded. Results The average operation time was 210 min. The average blood loss was 900 ml. There were no severe complications during and after operation. All patients were followed up for 12-30 months with the average time of 20 months. The ESR and CRP were normal at 3rd month after operation. The rate of bone fusion was 100%. The neurological function was improved in all patients. Conclusion Transfacet debridement combined with bone grafting and internal fixation via paraspinal approach was a safe and effective surgery in the treatment of thoracic tuberculosis, and it can achieve less surgery injury, convenient operation, reliable fixation.