| 前方入路病灶清除植骨融合内固定治疗颈胸段结核 |
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投稿时间：2011-08-16
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| 期刊信息：《中国骨伤》2012年，第25卷，第4期，第291-294页 |
| DOI：10.3969/j.issn.1003-0034.2012.04.008 |
| 基金项目: |
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中文摘要:
目的：探讨前方入路结核病灶清除、自体或同种异体髂骨移植、钢板内固定治疗颈胸段结核的效果。
方法：2000年6月至2010年12月,采用标准右前方入路联合胸骨柄正中劈开显露病变椎体,行病灶清除、植骨融合和内固定术治疗颈胸段结核患者20例,男17例,女3例；年龄25～46岁,平均38岁；病史3个月～2年,平均12个月。患者慢性发病,颈部持续性疼痛、僵硬、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：C7-T1 10例,T1 6例,T1-T3 3例,T2-T3 1例。颈胸段后凸Cobb角25°～60°,平均35°。术前Frankel分级：A级2例,B级4例,C级7例,D级2例,E级5例。术后定期复查X线片了解Cobb角变化和椎间植骨融合情况,采用NDI(颈椎残障功能量表)和Frankel分级评定术后临床症状和脊髓功能恢复情况。
结果：术中无大血管、脊髓或喉返神经损伤,20例患者均获随访,时间16～39个月,平均25个月。所有患者结核症状消失,无复发、切口感染、窦道形成或内固定失败等并发症,复查血沉结果正常。术后3～6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。末次随访Cobb角10°～16°,平均12°。NDI评分从术前的(48.2±2.9)分降低至终末随访的(22.5±3.1)分。除2例术前脊髓功能A级末次随访未见恢复外,其余患者脊髓功能Frankel分级平均提高1.5级,其中A级2例,B级1例,C级1例,D级3例,E级13例。
结论：经前方入路显露颈胸段结核病灶安全可靠,椎管减压效果显著,病灶清除后行自体或同种异体髂骨植骨,钢板内固定可有效重建颈胸段脊柱的稳定性。 |
| 【关键词】颈椎 胸椎 结核,脊柱 骨移植 骨折固定术,内 |
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| Debridement and bone grafting with internal fixation via the anterior approach for treatment of cervicothoracic tuberculosis |
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ABSTRACT
Objective:To investigate the outcome of radical debridement,reconstruction with bone autograft or allograft and plate internal fixation via the anterior approach for the treatment of cervicothoracic tuberculosis.
Methods:From Jun. 2000 to Dec. 2010,20 patients with cervicothoracic tuberculosis were treated by debridement and bone grafting with internal fixation via the anterior approach. They included 17 males and 3 females who ranged in age from 25 to 46 years (mean 38 years). The course of disease ranged from 3 months to 2 years (mean 12 months). The onset of the disease was chronic in all patients,with main complaints of persistent pain,and cervical stiffness and deformity accompanied with low fever,night sweating and pathologic leanness. Preoperative X-ray,CT or MRI showed that the pathologic change occurred in C7-T1 segment in 10 cases,T1 segment in 6 cases,T1-T3 segment in 3 cases,and T2-T3 segment in1 case. The Cobb angle ranged from 25° to 60°(mean 35°)before surgery. The Frankel classification was as follows:2 cases at grade A,4 cases at grade B,7 cases at grade C,2 cases at grade D,and 5 cases at grade E. All the patients underwent a standard cervical approach by combined partial median steotomy and transverse steotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Radical debridement was performed,and then a tricortical iliac crest bone autograft or allograft was placed and secured by internal fixation to reconstruct the spinal column. The change in Cobb angle and fusion of bone grafting were reexamined by X-ray regularly. The clinical symptoms and neurological function were evaluated according to NDI (neck disability index) score and Frankel classification.
Results:There was no injury to blood vessels,spinal cord or recurrent nerve during surgery. All patients were followed-up from 16 to 39 (mean 25) 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 patients. ESR re-examination recovered normally. Bony fusion was obtained in all patients and internal fixation position was normal at 3 to 6 month postoperatively. The Cobb angle ranged from 10° to 16° (mean 12°) and NDI was reduced from (48.2±2.9) to (22.5±3.1) at the final followed-up. Except for 2 patients at grade A showing no recovery preoperatively,the Frankel classification of the other patients raised 1.5 grade on average at the final followed-up,and the nerve function of the spinal cord recovered at different degrees:2 at grade A,1 at grade B,1 at grade C,3 at grade D,and 13 at grade E.
Conclusion:The anterior approach can provide direct and safe access to the lesion. The decompression effect of the vertebral canal is significant. The structural iliac crest autograft or allograft and anterior instrumentation could work effectively to stabilize the cervicothoracic junction. |
| KEY WORDS Cervical vertebrae Thoracic vertebrae Tuberculosis,spinal Bone transplantation Fracture fixation,intenal |
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| 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,刘雪梅,葛宝丰.前方入路病灶清除植骨融合内固定治疗颈胸段结核[J].中国骨伤,2012,25(4):291~294 |
| 英文格式: | LAN Xu,XU Jian-zhong,LIU Xue-mei,GE Bao-feng.Debridement and bone grafting with internal fixation via the anterior approach for treatment of cervicothoracic tuberculosis[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(4):291~294 |
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