Ⅰ期手术经后路病灶清除内固定治疗儿童胸椎结核
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作者Author单位AddressE-Mail
蓝旭 LAN Xu 兰州军区总医院创伤骨科, 甘肃 兰州 730050 Department of Orthopaedics, Lanzhou General Hospital, Lanzhou Command of CPLA, Lanzhou 730050, Gansu, China lzzyjw@sina.com 
许建中 XU Jian-zhong 第三军医大学西南医院骨科, 重庆 400038  
罗飞 LUO Fei 第三军医大学西南医院骨科, 重庆 400038  
刘雪梅 LIU Xue-mei 兰州军区总医院创伤骨科, 甘肃 兰州 730050 Department of Orthopaedics, Lanzhou General Hospital, Lanzhou Command of CPLA, Lanzhou 730050, Gansu, China  
葛宝丰 GE Bao-feng 兰州军区总医院创伤骨科, 甘肃 兰州 730050 Department of Orthopaedics, Lanzhou General Hospital, Lanzhou Command of CPLA, Lanzhou 730050, Gansu, China  
期刊信息:《中国骨伤》2013年,第26卷,第4期,第320-323页
DOI:10.3969/j.issn.1003-0034.2013.04.014
基金项目:
中文摘要:

目的: 探讨I期手术经后路结核病灶清除植骨融合内固定治疗儿童胸椎结核的效果。

方法: 2005年6月至2010年12月采用病灶清除植骨融合内固定治疗儿童胸椎结核9例, 其中男7例, 女2例;年龄3~12岁, 平均7岁;病史3个月~1年, 平均6个月。患儿均有不同程度胸背痛、肋间神经痛以及脊柱后凸畸形, 同时伴有低热、盗汗、消瘦等全身症状。术前X线片、CT、MRI检查提示病变部位多发生于T4-T9节段。胸段后凸角35°~72°, 平均 48.2°。术前脊髓功能ASIA 分级:B 级2例, C级5例, D级2例。术后定期复查X线片了解后凸角变化和椎间植骨融合情况, 采用ASIA分级评定术后脊髓功能恢复情况。

结果: 术中无大血管或脊髓损伤, 术后随访16~38个月, 平均24个月。所有患儿结核症状消失, 无结核复发、切口感染、窦道形成或内固定失败等并发症, 复查血沉正常。术后4~8个月复查X线片提示椎间植骨均获骨性愈合, 内固定位置正常。最后随访后凸角12°~30°, 平均19.5°, 脊髓功能ASIA分级:C级2例, D级2例, E级5例。脊髓功能均有不同程度改善。

结论: Ⅰ期经后路清除胸椎结核病灶彻底, 椎管减压可靠, 矫形效果显着, 行自体或同种异体骨植骨钉棒系统内固定可有效重建胸段脊柱的稳定性。
【关键词】儿童  胸椎  结核,脊柱  骨移植  内固定器
 
One-stage debridement and bone grafting with internal fixation via posterior approach for treatment of children thoracic spine tuberculosis
ABSTRACT  

Objective: To investigate the outcome of the children with thoracic spine tuberculosis who underwent radical debridement,reconstruction with bone autograft or allograft and internal fixation via posterior approach.

Methods: From June 2005 to December 2010,9 children with thoracic spine tuberculosis underwent radical debridement,reconstruction with bone autograft or allograft and internal fixation via posterior approach including 7 males and 2 females with an average age of 7 years old ranging from 3 to 12 years. The course of the disease ranged from 3 months to 1 year (averaged 6 months). All the patients had continuous thoracic and back pain,intercostal nerve pain and kyphosis deformity,accompanied with low fever,night sweat and pathologic leanness. The predilection sites examined by X-ray,CT or MRI were in T4 to T9 segment. The kyphosis angle ranged from 35° to 72° (averaged 48.2°) before surgery. The ASIA classification was as follows:2 cases at grade B,5 at grade C,2 at grade D. All the patients underwent a standard one-stage operation via posterior approach. Radical debridement was performed,then iliac crest bone autograft or allograft was placed and transpedicular screw system internal fixation was done to reconstruct the spinal column. The change of kyphosis angle and fusion of bone grafting were reexamined by X-ray regularly. The neurological function were evaluated according to ASIA classification.

Results: There was no injury of blood vessel or spinal cord during the surgery. Nine children were followed-up for 16 to 38 months (averaged 24 months). The tuberculosis symptoms disappeared after surgery and there was no tuberculosis recurrence,incision infection,sinus formation and internal fixation failure in any of these chiildren. ESR reexamination recovered normally. Bony fusion was obtained in all patients and internal fixation position was normal 4 to 8 month postoperatively. The kyphosis angle ranged from 12° to 30°(averaged 19.5°)at final followed-up. The function of spinal cord improved postoperatively,the function of spinal cord recovered at different degrees: 2 cases at grade C,2 at grade D,and 5 at grade E.

Conclusion: The one-stage posterior approach can provide direct and safe access to the lesion. The effect of vertebral canal decompression and kyphosis deformity correction were significantly. The structural iliac crest autograft or allograft and posterior transpedicular screw system could work effectively to stabilize the thoracic junction.
KEY WORDS  Child  Thoracic vertebrae  Tuberculosis,spinal  Bone transplantation  Internal fixators
 
引用本文,请按以下格式著录参考文献:
中文格式:蓝旭,许建中,罗飞,刘雪梅,葛宝丰.Ⅰ期手术经后路病灶清除内固定治疗儿童胸椎结核[J].中国骨伤,2013,26(4):320~323
英文格式:LAN Xu,XU Jian-zhong,LUO Fei,LIU Xue-mei,GE Bao-feng.One-stage debridement and bone grafting with internal fixation via posterior approach for treatment of children thoracic spine tuberculosis[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(4):320~323
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