前后路一期手术治疗多节段胸椎结核并截瘫

目的 探讨一期胸膜外肋骨、横突切除入路病灶清除、钛网植骨联合后路钉(钩)一棒系统内固定治疗多节段胸椎结核的临床疗效及行病椎内固定的可行性及优越性.方法 回顾性分析2000年1月至2007年12月治疗的23例多节段胸椎结核并截瘫患者,男9例,女14例;年龄18～61岁,平均32.8岁.术前均行胸椎X线、加密CT扫描及MR检查.按影像学结果拟定病椎行椎弓根钉和(或)钩内固定.若前、中柱正常组织50%,选择椎弓根钉或钩内固定;若前、中柱正常组织<50%,选择椎板钩内固定或不固定.按Frankel神经功能分级评定患者手术前后神经功能变化,根据X线片测量手术前后后凸畸形Cobb角及随访中角度丢失情况并观察钛网植骨融合情况.结果 钛网植骨融合时间平均8.7个月;红细胞沉降率恢复正常时间平均为术后5.8个月.均得到了门诊随访,平均随访18.6个月.后凸畸形Cobb角由术前的平均46.8°矫正至术后的平均20.7°,末次随访平均丢失2.6°.末次随访神经功能Fankel分级,C级4例,D级3例,E级16例.发生胸膜损伤1例,脱钩1例.未发现窦道形成,无椎体结核复发,无椎弓根钉、钛网及棒松动、断裂等.结论 一期胸膜外肋骨、横突切除入路病灶清除、钛网植骨并后路钉(钩)一棒系统内固定治疗多节段胸椎结核可取得良好的临床疗效;在无椎体后柱结构破坏的病椎中选择行钉(钩)-棒系统内固定是一种行之有效的方法,固定确切且可减少内固定范围.

The treatment of multilevel thoracic tuberculous associated paraplegia with one-staged anterior and posterior operation

Objective To study the clinical results of treatments of multiple thoracic tuberculous associated paraplegia with one-staged anterior vertebrectomy, interbedy titanium mesh cage, autologous bone grafts, posterior internal fixation with nail (hook)-rod system, and to investigate the feasibility and the advan- tages of internal fixation for pathologic vertebra. Methods Twenty-three patients with multilevel thoracic tuberculous were treated in our department from Jan, 2000 to Dec. 2007, including 9 males and 14 females, with the mean age of 32.8 years (ranged from 18 to 61 years). All patients underwent thoracic spine X-ray, CT scan and MRI examination of pathologic vertebra before surgery. The podicle screw was placed when the normal remaining vertebral body was larger than 50%, and the laminar hook or nothing was placed if that smaller than 50%. To assess the neurological function in the patients with neurological changes before and after surgery according to the Frankel grade, and to observe the situation and fusion of the titanium mesh cage, according to X-ray measurements kyphosis Cobb angle before and after operation and the lost in the follow-up. Results The 23 cases of patients received follow-up for average 18.6 months. The correction of Cobb angle was from average 46.8° preoperatively to 20.7° postoperatively, and the lost was average 2.6°at the last follow-up. 4 cases were C, 3 cases were D and 16 cases were E of the Fankel grade at the last fol- low-up. There were found pleural injury of 1 case and hook dislocation of 1 case, and no found sinus forma- tion, vertebral tuberculous relapse and no loose and fracture of screws, rods and titanium mesh cages. Con- clusion It can get a good clinical efficacy to treat multiple thoracic tuberculous with one-staged surgical operation combined anterior vertebrectomy, interbody titanium mesh cage, autologous bone grafts, posterior internal fixation with nail (hook)-rod system, and can get fixation firmly and reduce the range of fixation.