胸腔镜辅助小切口胸椎结核前路重建手术的临床研究

目的评价应用胸腔镜辅助小切口技术进行胸椎结核前路重建术的临床疗效。方法回顾性分析应用胸腔镜辅助小切口技术进行脊柱前路重建的60例胸椎结核病例。其中男性38例,女性22例。年龄19~68岁,平均47·4岁。病变累及T4-T12椎体。50例有明显椎旁脓肿,17例合并胸膜炎,硬膜囊受压42例。术前拟融合节段后凸角度平均29·2°(18°~42°)。术前神经系统功能Frankel分级:A级1例;B级4例;C级6;D级19例;E级30例。结果60例手术顺利完成。均采用钉棒内固定。其中自体髂骨植骨32例,钛网28例。平均手术时间230min(180~320),平均出血量570(350~1200)ml,平均胸腔置管引流时间3·6d(3~5d)。临床疗效优良率91·7%。术后融合节段后凸角度平均18·5°(16°~33°),矫正率36·6%。术后并发症18例,发生率30%。经术后2~6年,平均3·4年随访,无内固定松动和断裂,矫正度无明显丢失,均获得良好植骨融合。30例末次随访术后神经功能获1~3级改善。结论胸腔镜辅助小切口技术为胸椎结核前路重建提供了一种较为简易、安全、有效、实用的脊柱微创手术方法。

Clinical research of thoracoscopy-assisted mini-open surgery for anterior column reconstruction of thoracic spine tuberculosis

OBJECTIVE: To evaluate the clinic effects of thoracoscopy-assisted mini-open surgery for anterior column reconstruction of thoracic spine tuberculosis. METHODS: Sixty patients with thoracic spine tuberculosis, involving segments T4 to T12, with a kyphotic angle of 29.2 degrees (18-42 degrees), 38 males and 22 females, aged 47.4 (19-68), with large paraspinal abscess in 50 cases, pleurisy in 17, and dural compression in 42 cases shown by imaging examination, underwent thoracoscopic-assisted mini-open surgery, including radical debridement and anterior spinal reconstruction. According to Frankel's grade, the preoperative neurological function was judged as: Grade A in 1 case, Grade B in 4, Grade C in 6, Grade D in 19, and Grade E in 30. The patients were followed up for 3.6 years. The outcomes were evaluated retrospectively. RESULTS: The operation was accomplished successfully in all 60 patients. The average operative time was 230 min (180-320 min), the average blood loss during operation was 570 ml (350-1200 ml), the mean drainage duration was 3.6 d (3-5 d). Complications occurred in 18 patients (30%). 30 patients showed neurological improvement from 1 to 3 Grades at the last follow-up. The average correction rate of kyphotic angle was 36.6%, and no obvious correction loss was detected during the follow-up. No patient showed recurrence of tuberculosis. CONCLUSION: Thoracoscopy-assisted mini-open surgery provides a simple, safe, effective, and practical technology with minimal invasiveness for the treatment of thoracic spine tuberculosis.