【摘要】：目的:探討頸胸段脊柱結(jié)核病灶部位與胸骨柄上緣切跡位置關(guān)系對手術(shù)治療策略選擇的影響及臨床預(yù)后。方法:2003年1月~2013年1月45例頸胸段脊柱結(jié)核患者采用手術(shù)治療,其中男29例,女16例;年齡17~62歲(35.4±16.7歲)。病變節(jié)段:C7~T1 8例,T1 11例,T1~T2 7例,T2 6例,T2~T3 8例,T3 5例。術(shù)前神經(jīng)功能ASIA分級:A級2例,B級5例,C級9例,D級22例,E級7例。術(shù)前頸胸段后凸成角、頸椎殘障功能量表(neck disability index,NDI)評分和JOA評分分別為34.7°±6.8°、39.6±4.6及10.7±2.8。根據(jù)患者頸胸段MRI矢狀位上胸骨柄上緣切線與結(jié)核病灶的關(guān)系采取不同手術(shù)方案,19例椎體結(jié)核病灶位于胸骨柄上緣水平切跡線之上的患者采用一期前路病灶清除、植骨融合內(nèi)固定術(shù),26例病灶平齊于胸骨柄上緣水平切跡線或在之下的患者采用一期前路病灶清除、植骨融合及后路植骨融合內(nèi)固定術(shù)。術(shù)前及術(shù)后均用四聯(lián)敏感抗結(jié)核藥物規(guī)律治療。對患者后凸成角、NDI評分和JOA評分變化情況進(jìn)行統(tǒng)計(jì)學(xué)分析來評價療效。結(jié)果:手術(shù)時間為178.0±48.3min;術(shù)中出血量為590.0±76.4ml。隨訪6.6±3.2年(3~13年),在隨訪期內(nèi)無內(nèi)固定松動、斷裂、失敗等情況出現(xiàn)。末次隨訪時患者頸胸段后凸成角、NDI評分及JOA評分分別為10.2°±2.4°、11.4±3.6及17.6±2.4,與術(shù)前比較均有統(tǒng)計(jì)學(xué)差異(P0.05)。1例單純行一期前路病灶清除、植骨融合內(nèi)固定術(shù)治療的患者在術(shù)后6個月時手術(shù)切口竇道形成,再次行一期前路內(nèi)固定取出、病灶擴(kuò)大清除植骨融合和二期后路植骨融合內(nèi)固定治療,隨訪5.5年結(jié)核治愈。其余44例患者在術(shù)后7.2±1.1個月獲得融合。在伴有神經(jīng)功能減退的38例患者中,29例(76%)末次隨訪時神經(jīng)功能ASIA分級提高1~3級,9例分級無變化。結(jié)論:頸胸段脊柱結(jié)核患者在規(guī)律抗結(jié)核藥物治療的基礎(chǔ)上,根據(jù)患者頸胸段MRI矢狀位上胸骨柄上緣切線與結(jié)核病灶的關(guān)系,對不同類型患者采用不同手術(shù)方式可完成徹底的病灶清除、固定及融合,中長期隨訪效果較好。
[Abstract]:Objective: to investigate the relationship between the location of cervical and thoracic spinal tuberculosis and the location of superior margin notch of sternum stalk on the choice of surgical treatment strategy and clinical prognosis. Methods: from January 2003 to January 2013, 45 patients with cervical and thoracic spinal tuberculosis were treated with surgical treatment, including 29 males and 16 females, with an age of 1762 years (35.4 鹵16.7 years). There were 8 cases of T 1 with T1T 1 and 7 cases of T 2 T 2 T 2 with T 2 T 3 in 8 cases with T 2 T 3 and T 3 with T 3 in 8 cases. Preoperative neurological function ASIA grade: 2 cases were grade A, 5 cases were grade B, 9 cases were grade C, 22 cases were grade D, 7 cases were grade E. (neck disability index,NDI and JOA scores were 34.7 擄鹵6.8 擄and 39.6 鹵4.6 and 10.7 鹵2.8 respectively. According to the relationship between the superior margin tangent of the superior sternum in the MRI sagittal position of the cervical and thoracic segment and the tuberculosis foci, 19 patients with vertebral tuberculosis foci located above the horizontal notch line of the superior sternum were removed by one stage anterior approach. Bone graft fusion and internal fixation were performed in 26 patients whose lesions were flat at the upper margin of sternum or below the horizontal incisors of sternum by one stage anterior debridement, bone graft fusion and posterior bone graft fusion and internal fixation. All patients were treated with four-drug-sensitive anti-tuberculosis drugs before and after operation. NDI score and JOA score were statistically analyzed to evaluate the curative effect. Results: the operative time was 178.0 鹵48.3 min and the intraoperative bleeding was 590.0 鹵76.4 ml. Follow-up of 6.6 鹵3.2 years (3 ~ 13 years) showed no internal fixation loosening, fracture and failure. At the last follow-up, the scores of NDI and JOA were 10.2 擄鹵2.4 擄11.4 鹵3.6 and 17.6 鹵2.4 respectively, which were significantly different from those before operation (P0.05). The patients treated with bone graft fusion and internal fixation were treated with incision sinus formation at 6 months after operation and were treated with one stage anterior fixation, extensive debridement and bone grafting fusion and secondary posterior bone graft fusion internal fixation. The tuberculosis was cured at a follow-up of 5.5 years. The remaining 44 patients were fused at 7.2 鹵1.1 months postoperatively. Of the 38 patients with neurologic dysfunction, 29 (76%) had no change in the ASIA grade at the last follow-up. Conclusion: on the basis of regular antituberculous drug therapy, the relationship between the superior margin of sternum in MRI sagittal position of cervical and thoracic segment and the focus of tuberculosis was found in patients with cervical and thoracic spinal tuberculosis. For different types of patients, different surgical methods can complete focus clearance, fixation and fusion, long-term follow-up results are better.
【作者單位】： 西安交通大學(xué)附屬紅會醫(yī)院脊柱外科;
【分類號】：R687.3

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