颈胸段结核手术治疗方式的选择

目的：探讨颈胸段脊柱结核的手术方式选择，及其临床预后。方法：2007年1月。2012年1月我院共收治21例颈胸段脊柱结核患者，根据胸骨柄上缘和病变节段的关系，15例患者行一期前路病灶清除、植骨融合、内固定术。6例患者行一期前路病灶清除、植骨融合，后路植骨融合内固定术。术前神经功能ASIA分级：B级2例，C级4例，D级8例，E级7例。结果：所有患者均获得随访，平均随访时间为41．6个月。所有患者在术后1年均获得骨性愈合，无1例发生内固定松动、移位、断裂。颈胸段后凸Cobb＇s角由术前的（30．8±5．7）°改善至末次随访的（10±2．3）°（P〈0．01）；ODI评分由术前的49．7±4．8改善至末次随访的23．1±3．4（P〈0．01）。术后患者的神经功能平均提高了1．6级，末次随访时ASIA分级D级2例，E级19例。结论：对于颈胸段结核，低位颈前入路可以实现病灶的彻底清除。应根据胸骨柄上缘水平切迹线和病变节段的关系，决定具体的个体化固定方式。

The selection of surgical method for cervicothoracic tuberculosis

Objective： To explore the surgical methods and clinical prognosis of cervicothoracic tuberculosis. Methods： From January 2007 to January 2012, 21 patients with cervicothoracic spinal tuberculosis were treated in our hospital. According to the relationship between superior border of manubrium and lesion seg- ments, 15 patients underwent one-stage anterior debridement, bone graft, and internal fixation, the other 6 patients underwent one-stage anterior debridement, bone graft, posterior bone graft and internal fixation. Pre- operative ASIA classification was evaluated as follows： grade B in 2, grade C in 4, grade D in 8 and grade E in 7 patients. Results： All patients were followed up for an average time of 41.6 months and got bony fusion 1 year after operation. There was no internal fixation loosening, displacement and breakage observed. The kyphosis Cobb＇s angle was improved from （30.8±5.7）° to （10±2.3）°, P〈0.01. ODI was reduced from 49.7±4.8 to 23.1±3.4, P〈0.01. ASIA classification raised 1.6 grade on average, grade D in 2 and grade E in 19 patients at the last visit. Conclusion： For cervicothotacic tuberculosis, lower anterior cervical approach can obtain a thorough debridement, the doctor should select a proper individual fixation method according to the relationship between uperior border of manubrium and lesion segments.