一期后路内固定并病灶清除植骨融合治疗上胸椎结核

目的：探讨一期后路椎弓根钉内固定、病灶清除、植骨融合治疗上胸椎结核的临床疗效。方法自2009年3月至2011年1月，应用脊柱后正中切口一期行椎弓根钉内固定、切除肋骨头及横突行侧前方病灶清除、植骨融合治疗上胸椎结核12例，其中男10例，女2例；年龄9～45岁，平均36.2岁；病变节段：T2～31例，T3～52例，T4～66例，T5～62例，T61例；所有患者均以胸背部疼痛首诊并伴不同程度的神经功能障碍，术前后凸角15°～52°，平均30.2°；Frankel分级B级2例，C级2例，D级8例；入院时查血沉平均71 mm/h，术前血沉平均35 mm/h。结果术后随访6～22个月，1例患者手术切口皮缘坏死经换药后愈合，余患者均一期愈合。术后1～3个月内血沉恢复至正常水平，胸椎后凸畸形均明显改善。术后后凸角度10°～27°，平均19°；植骨融合时间4～7个月，平均5个月，至终末随访时无结核复发及内固定相关并发症。末次随访时2例Frankel分级B级者恢复至C级，2例C级者1例恢复至D级，1例恢复至E级，8例D级恢复至E级。结论一期后路椎弓根内固定、病灶清除、植骨融合治疗上胸椎结核手术入路简单，创伤小，有利于恢复脊柱稳定性，矫正后凸畸形，且操作安全，并发症少。

One-stage Surgical Management for upper Thoracic Tuberculosis by Posterior Pedicule Screw-rods System Fixation,Debridement and Bone Graft

Objective Toinvestigatetheclinicalefficacyofone-stagesurgicalmanagementforupperthoracictuberculosis byposteriorpediculescrew-rodssystemfixation,debridementandbonegraft.Methods Atotalof12patientswithuppertho-racic tuberculosis were treated by one-stage spinal fixation with midline incision,removing front-side focus by rib and transverse resection,grafting surgeries from March 2009 to January 2011. There were 10 males and 2 females;with the age of 9 to 45 years,36. 2 years on average;1 case had segmental lesion at T2～3 ,2 at T3～5 ,6 at T4～6 ,2 at T5～6 and 1 at T6 . The primary symptom of all patients was chest and back pain with varying degrees of neurological dysfunction. The preoperative kyphosis was 15° to 52°,30. 2° on average. There were 2 cases of grade of B,2 cases of grade C and 8 of grade of D in Frankel grading. The average erythrocyte sedimention rate on admission was 71 mm/h,and the average preoperative ESR was 35 mm/h. Results Allpatientswerefollowedupfor6～22months.Therewasonecaseofskinnecrosisandalltheotherwouldhealed.TheERS decrsead to normal range in 1～3 months postoperative. Thoracic kyphosis were significantly improved,the postoperative kypo-sis was 10°～27°,19° on average. Spinal fusion was achieved in 4 to 7 months,5 months on average. There was no recurrence or fixation-related complications at the final follow up. 2 cases of grade B recoverd to grade C,1 of grade C to grade D and an-othertogradeE,8ofgradeDtogradeE.Conclusion Thissurgicaltechniqueisasimpleandlessinvasivewayto.Treating upper thoracic tuberculosis,it is helpful to restore the spinal stability,correct the kyphosis,and the operation is safe and with few complications.