经胸入路一期病灶清除椎弓根钉内固定治疗胸椎结核

目的：探讨经胸入路一期病灶清除Z-PCATE钉内固定治疗胸椎结核的疗效.方法：2002年3月至2008年7月共收治胸椎结核患者36例,均伴有胸背疼痛、乏力、低热、盗汗等结核中毒症状,其中11例有后凸畸形,平均Cobb角27°;20例伴神经功能障碍,Frankel分级B级1例,C级9例,D级10例.全部采用胸膜外采用经胸腔入路,行病灶清除、Z-PCATE内固定.术后卧床2～3个月、继续抗痨12～18月.结果：平均随访20个月,疗效满意,1年内结核病无复发,所有患者内固定无松动或断裂.未发生肺部感染及呼吸衰竭等并发症.胸背疼痛及结核中毒症状消失;结论：彻底病灶清除、加内固定,可重建脊柱的稳定性,有利于结核病灶的稳定与修复,在病灶内植入内固定器械是安全可行的.

Transthoracic approach anterior radical debridement and pedicle screw fixation for the treatment of thoracic tuberculosis

Objective：Discussion after one stage radical debridement and anterior interbody Z--PCATE nail： internal fixation in the treatment of thoracic tuberculosis patients. The HTH ＇ HTK ＇ method in 2002 March to 2008 July： treatment of thoracic spinal tuberculosis patients with 36 cases, all accompanied with chest and back pain, fatigue, fever, night sweats, tubercular toxic symptoms, including 11 patients with kyphosis, average Cobb angle is 27 degrees; 20 cases with neurological dysfunction, 1 cases of Frankel grade B, class C in 9 cases, 10 cases of grade D. All use of extrapleural by thoracic approach focus clearance, line, Z-- PCATE internal fixation. Postoperative bed rest for 2 to 3 months, to continue for 12 to 18 months of anti--tuberculosis. The HTH ＇ HTK ＇： results of a mean follow--up of 20 months, the curative effect is satisfied, 1 years without recurrence in patients with tuberculosis, all without loosenir/g or fracture internal fixation. Without the occurrence of pulmonary infection and respiratory failure and other complications. Chest and back pain and tubercular toxic symptoms disappeared; the HTH ＇ in HTK ＇ conclusions： thorough debridement, combined with internal fixation, but the reconstruction of spinal stability, conducive to tuberculosis in stabilization and repair, intralesional implantation of internal fixation devices are safe and feasible.