一期前路病灶旷置术治疗上颈椎结核

目的探讨病灶旷置术在上颈椎结核治疗中的临床疗效。方法回顾性分析2006年1月—2016年5月收治的7例上颈椎结核患者临床资料,根据寰枢椎椎体破坏程度,分别采用头颈胸石膏外固定(2例)、单纯后路寰枢椎内固定融合术(3例)、枕颈融合内固定融合术(2例)治疗,均未行结核病灶清除术。采用疼痛视觉模拟量表(VAS)评分评估上颈椎疼痛程度,日本骨科学会(JOA)评分评估脊髓神经功能,红细胞沉降率(ESR)评估结核控制情况。所有患者治疗后继续规范抗结核治疗18个月。结果 5例手术治疗患者手术顺利,手术时间(165±32)min,术中出血量(152±45)mL;术后随访18个月～10年,平均38.6个月。随访期间7例患者结核无复发,抗结核治疗18个月后均达到临床治愈标准。末次随访时,上颈椎VAS评分由治疗前(5.3±1.8)分降至(1.6±1.3)分,JOA评分由治疗前(13.5±2.8)分升至(15.9±0.8)分,ESR由治疗前(65.0±12.6)mm/h降至(13.0±2.6)mm/h。末次随访时所有患者均获得骨性融合,未见继发上颈椎骨性畸形。所有患者均无需二期前路清创治疗。结论一期前路上颈椎结核病灶旷置术通过稳定上颈椎并结合规范抗结核治疗,可控制结核病灶的发展,患者可获得临床治愈,是一种值得推广的治疗新思路。

One-stage tuberculosis exclusion for upper cervical tuberculosis

Objective To evaluate the clinical effect of tuberculosis exclusion in the treatment of upper cervical tuberculosis. Methods Clinical data of 7 patients with upper cervical tuberculosis treated by one-stage tuberculosis exclusion from January 2006 to May 2016 were reviewed retrospectively. According to the degree of atlantoaxial vertebral destruction, the patients were treated with plaster fixation of head and neck (2 cases), posterior atlantoaxial internal fixation and fusion (3 cases), and occipitocervical internal fixation and fusion(2 cases). All the patients were not treated by anterior debridement. The visual analogue scale (VAS) score was used to assess the degree of upper cervical pain. The Japanese Orthopaedic Association (JOA) score was used to evaluate the neurological function. The erythrocyte sedimentation rate(ESR) was used to evaluate the tuberculosis inflammation. Regular anti-tuberculous treatment was performed postoperatively for at least 18 months. Results All the operations (5 cases) were successfully completed. The operation time was (165±32)min and the intraoperative blood loss was (152±45)mL. Postoperative follow-up ranged from 18 months to 10 years, with an average of 38.6 months. During the follow-up period, all the patients (7 cases) had no recurrence of tuberculosis, and achieved clinical cure after 18 months of anti-tuberculous treatment. At the final follow-up, the VAS score decreased from (5.3±1.8) to (1.6±1.3), and the JOA score increased from(13.5±2.8) to(15.9±0.8), and the ESR decreased from(65.0±12.6)mm/h to(13.0±2.6)mm/h. All the patients obtained bone fusion, and no secondary bone deformity of the upper cervical was found. All the patients didn''t need secondary anterior debridement. Conclusion With appropriate preoperative anti-tuberculosis treatment, the upper cervical tuberculosis can be treated by one-stage tuberculosis exclusion with fixation. It is a new treatment of upper cervical tuberculosis that the patient can obtain clinical cure.