颈胸交界处椎体结核的个性化手术治疗策略

目的探讨颈胸交界处椎体结核个性化手术治疗方法。方法回顾性分析2006年6月-2012年6月收治的16例颈、胸交界处椎体结核，6例采用低位下颈椎前方入路联合胸骨柄劈开术，5例采用右侧前方经肩胛下开胸入路，5例采用单纯经后路入路，行病灶清除、椎体间钛网植入（或植骨）及内固定术治疗。结果16例均获得随访，时间平均2年，患者血红细胞沉降率恢复正常，植骨完全融合，无螺钉松动、脱落及钢板断裂等并发症。术后神经功能恢复按Frankel分级，全部恢复到E级。结核病灶无复发，术后后凸Cobb角较术前明显改善，末次随访后凸Cobb角无明显丢失。结论颈胸交界处椎体结核应根据不同节段椎体及椎体破坏程度选择不同的手术入路及固定方法。

Individualized Surgical Approach for Spinal Tuberculosis in Cervicothoracic Junction

Objective To explore the individualized method of surgical approach for spinal tuberculosis in cervi- cothoracic junction. Methods Clinical data of 16 patients with spinal tuberculosis of cervicothoracic junction admitted during June 2006 and June 2012 was retrospectively analyzed. Six patients underwent lower cervical anterior approach combined with manubrium-splitting approach, five patients underwent thoracic approach in the anterior right scapular, and five patients underwent posterior approach. All patients were treated with debridement, titanium mesh implantation or bone graft and internal fixation by different surgical approaches. Results All patients were followed up for an average of two years. Patients＇erythrocyte sedimentation rate was put back, bone graft was completely fused, and there were no com- plications such as loosing or shedding of screws, and nickelclad breakage. Nerval functional recovery of all patients after operation reached grade E by Frankel classification, There was no recurrence of tuberculose focus or loss of Cobb angle till the last follow-up, and posterior protruding Cobb angle was improved after operation than that before operation. Con- clusion The spinal tuberculosis in cervicothoracie junction should be treated with different surgical approaches and fixed methods according to segments of the vertebral body and damage degrees.