一期开胸病灶清除加椎弓根固定治疗儿童胸椎结核35例分析

目的 探讨后路椎弓根固定联合前路开胸病灶清除治疗儿童胸椎结核的疗效。 方法 搜集首都医科大学附属北京胸科医院2004年1月至2010年12月采用后路椎弓根固定联合前路开胸病灶清除治疗儿童胸椎结核35例，其中有13例合并不同程度瘫痪,1例合并尿潴留。术后随访1～7年，平均3.5年，对患者局部病灶有无复发、症状改善情况，以及后凸畸形矫正的近期和远期变化情况进行分析。 结果 35例患者均得到结核病临床治愈，未发现复发；13例合并不同程度瘫痪者下肢肌力均提高1～3级；1例尿潴留患者于术后5个月恢复排尿功能；35例患者术前平均后凸Cobb角为42°（20°～55°），术后近期平均为22°（5°～38°），术后随访1～7年（平均3.5年），后凸Cobb角仍平均为22°（5°～40°），其中17例于术后2～3年取出内固定。 结论 后路椎弓根固定联合前路开胸病灶清除治疗儿童胸椎结核能够一期完成病灶清除，脊髓减压彻底，提供肋骨植骨，重建脊柱稳定性，有效矫正后凸畸形，预防远期后凸畸形加重。

The analysis of posterior transpedicular fixation combined with anterior thoracotomy debridement to treat 35 children with thoracic spinal tuberculosis

Objective To evaluate efficacy of posterior transpedicular fixation combined with anterior thoracotomy debridement to treat thoracic spinal tuberculosis in children. Methods Thirty-five cases admitted in our hospital from Jan. 2004 to Dec. 2010 were taken posterior transpedicular fixation combined with anterior thoracotomy debridement. Among the 35 cases, there were 13 cases with varying degrees of paralysis and one case with urinary retention. All cases were postoperatively followed up for 1 to 7 years, average 3.5 years, and to be analyzed the local lesions recurrence or not, symptom improvement and correction of kyphosis in the short-term and long-term variation. Results Thirty-five patients were all cured and found no recurrence. Of the 13 patients with varying degrees of paralysis, lower extremity muscle strength was increased by 1 to 3 levels. The patient with urinary retention postoperatively recovered at 5th month later. Of all cases, the preoperative average kyphosis cobb’s angle was 42°（20°to 55°）, and postoperative average cobb’s angle was 22°（5°to 38°） in the short-term and still 22°（5° to 40°） in the long-term. Among the 35 cases, 17 cases were removed the implants after 2 to 3 years. Conclusion Posterior transpedicular fixation combined with anterior thoracotomy debridement taken to treat thoracic spinal tuberculosis in children can complete debridement, decompress spinal cord thoroughly, provide rib bone to be grafted, reconstruct spinal stability, correct kyphosis deformity effectively and prevent kyphosis increased.