自体肋骨捆绑移植重建胸椎结核病灶清除术后骨缺损

发布时间：2018-08-07 10:29

【摘要】：目的探讨自体肋骨捆绑移植重建治疗胸椎结核病灶清除术后骨缺损的疗效。方法 2006年1月—2013年12月,采用前路病灶清除、捆绑肋骨椎间植骨融合,前路或后路内固定术治疗36例胸椎结核术后骨缺损。男20例,女16例;年龄21~60岁,平均50.5岁。病程5~11个月,平均6.8个月。胸椎结核位于T_(4、5) 1例,T_(5、6) 4例,T_(6、7) 4例,T_(7、8) 4例,T_(8、9) 9例,T_(9、10) 8例,T_(10、11) 5例,T_(11、12) 1例。伴神经损害34例,根据Frankel分级为B级2例、C级8例、D级24例。记录患者手术前后红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP)、疼痛视觉模拟评分(VAS)及胸椎后凸Cobb角;根据CT三维重建分析植骨融合情况。结果术后测量捆绑肋骨的横截面积为136.8~231.2 mm~2,平均197.1 mm~2;相邻上、下位椎体终板表面积为425.0~677.6 mm~2,平均550.6 mm~2;肋骨占终板表面积百分比为29%~50%,平均33.6%。手术时间125~160 min,平均125 min;术中出血量280~850 mL,平均450 mL。患者均获随访,随访时间2~8年,平均4.4年。术后出现肋间神经痛2例、胸腔积液1例、结核药物导致肝功能损害2例,均经对症治疗后治愈。其余患者未发生任何呼吸道并发症及伤口感染,无肋骨支撑体骨折、移位和吸收,无结核病灶复发,无内固定物松动断裂、脊柱后凸畸形。术后6个月三维CT示融合率为86.1%(31/36),术后12个月为97.2%(35/36)。术后3个月及末次随访时ESR、CRP、VAS评分及胸椎后凸Cobb角均较术前显著改善(P0.05),术后3个月及末次随访间比较差异无统计学意义(P0.05)。术前Frankel分级B级2例均恢复至D级,术前C级8例恢复至D级1例、E级7例,术前D级24例均恢复至E级。结论对中下胸椎结核病灶清除术后小于2个椎体和椎间盘的骨缺损,采用自体肋骨捆绑支撑移植是可行的。
[Abstract]:Objective to evaluate the effect of bone defect after thoracic vertebrae tuberculosis removal by bone reconstruction with autologous rib grafting. Methods from January 2006 to December 2013, 36 patients with thoracic spinal tuberculosis were treated with anterior debridement, intervertebral bone fusion and anterior or posterior internal fixation. There were 20 males and 16 females, aged from 21 to 60 years (mean 50.5 years). The course of disease ranged from 5 to 11 months (mean 6.8 months). Thoracic vertebral tuberculosis was located in T _ (4O _ 5), 1 case, T _ (5N _ 6), 4 cases, T _ (6N), 4 cases, T _ (7N), 4 cases, T _ (8O 9), 9 cases, T _ (9O 10), 8 cases, T _ (1010), 5 cases, T _ (1112), 1 case. There were 34 cases with nerve damage and 24 cases with grade D according to Frankel classification. The erythrocyte sedimentation rate (erythrocyte sedimentation rateur) C-reactive protein (C reactive), pain visual analogue score (VAS) and thoracic kyphosis Cobb angle were recorded before and after operation. Results the cross sectional area of the rib was 136.8 / 231.2 mm / 2 (mean 197.1 mm / 2), the surface area of the inferior vertebral endplate was 425.0 / 677.6 mm / 2 (mean 550.6 mm / 2) and the ratio of rib to the end plate was 290.50 mm / 2 (mean 33.6 mm / 2). The operative time was 125 ~ 160 min with an average of 125 min, and the blood loss during operation was 280 ~ 850 mL, with an average of 450 mL. All patients were followed up for 2 ~ 8 years (mean 4.4 years). There were 2 cases of intercostal neuralgia, 1 case of pleural effusion and 2 cases of liver function damage caused by tuberculosis drugs. There were no respiratory complications and wound infection, no rib support fracture, displacement and absorption, no recurrence of tuberculosis, no internal fixation loosening and rupture, kyphosis deformity. The fusion rate was 86.1% (31 / 36) on 3D CT and 97.2% (35 / 36) at 12 months postoperatively. The VAS score and the Cobb angle of thoracic kyphosis were significantly improved 3 months after operation and at the last follow-up (P0.05), but there was no significant difference between the three months after operation and the last follow-up (P0.05). Frankel grade B recovered to grade D in 2 cases, grade C to grade D in 8 cases, grade E to grade E in 7 cases, and grade D to grade E in 24 cases before operation. Conclusion it is feasible to remove the bone defect of less than 2 vertebrae and intervertebral disc in the middle and lower thoracic vertebrae.
【作者单位】：西南医科大学附属医院脊柱外科;西南医科大学附属医院影像科;
【基金】：四川省科技厅-泸州市科技局课题(Z1411) 西南医科大学附属医院支撑项目(16024)~~
【分类号】：R687.3

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