颈胸段结核手术治疗方式的选择

目的：探讨颈胸段脊柱结核的手术方式选择及其临床预后。方法2007年1月～2012年1月共收治21例颈胸段脊柱结核患者，根据胸骨柄上缘和病变节段的关系，15例患者行一期前路病灶清除、植骨融合、内固定术。6例患者行一期前路病灶清除、植骨融合、后路植骨融合内固定术。术前神经功能按美国脊髓损伤协会（ American spinal injury association， ASIA）分级：B级2例，C级4例，D级8例，E级7例。结果所有患者均获得随访，平均随访41．6个月。所有患者术后1年均获得骨性愈合，无一例发生内固定松动、移位、断裂。颈胸段后凸Cobb 角由术前的30．8°±5．7°改善至末次随访的10．0°±2．3°；颈椎功能障碍指数（neck disability index， NDI）由术前的39．7±4．8改善至末次随访的23．1±3．4。术后患者的神经功能平均提高了1．6级，末次随访时ASIA分级D级2例，E级19例。结论对于颈胸段结核，低位颈前入路可以实现病灶的彻底清除。应根据胸骨柄上缘水平切迹线和病变节段的关系决定具体个体化固定方式。

Selection of surgical method for cervicothoracic tuberculosis

Objective To explore the selection of surgical method for cervicothoracic tuberculosis and its clinical outcome. Methods From January 2007 to January 2012, 21 patients with cervicothoracic spinal tuberculosis were treated.According to the relationship between the upper edge of sternum and lesion segments,15 patients were underwent one-stage anterior debride-ment,bone graft, internal fixation.Six patients were underwent one-stage anterior debridement,bone graft, posterior bone graft and internal fixation.Preoperative American spinal injury association （ ASIA ） classification was as follows： grade B in 2 patients, grade C in 4 patients, grade D in 8 patients, grade E in 7 patients.Results All patients were followed up with an average time of 41.6 months.All patient got bone fusion at 1 year after operation.There was no internal fixation loosening、dis-placement, broken up.The Kyphosis Cobb’ s angle was improved from preoperative 30.8°±5.7°to postoperative 10.0°± 2.3°.Neck disability index （NDI） was reduced from preoperative 39.7 ±4.8 to postoperative 23.1 ±3.4 .The ASIA classifi-cation raised 1.6 grade on average at final follow up：grade D in 2 patients,grade E in 19 patients.Conclusion For cervico-thotacic tuberculosis, lower anterior cervical approach can get thoroughly debridement.Individual fixed mothed should be selected according to the relationship between the upper edge of sternum and lesion segments.