【摘要】 目的:探讨后路单侧椎板有限减压、病灶清除、椎间植骨融合内固定治疗伴椎管脓肿的胸椎脊柱结核的可行性及临床疗效。方法:37例胸椎脊柱结核患者均伴有椎管内脓肿占位。其中男24例,女13例;年龄13~68(39.7±9.1)岁。脊柱病变节段后凸Cobb角为8°~62°(29.6°±3.6°)。术前神经功能Frankel分级:B级3例,C级7例,D级19例,E级8例。采用后路单侧椎板有限减压、病灶清除、椎间植骨融合内固定治疗。结果:术后随访24~90(53.0±15.7)个月。1例患者术中出现硬脊膜撕裂,术后发生脑脊液漏,术后2例患者出现神经并发症,2例伤口延迟愈合。术后测量后凸角度为5°~21°(8.3°±1.3°),末次随访时后凸角度为8°~26°(10.1°±1.9°)。至末次随访,术前有神经症状患者均有不同程度恢复。根据神经功能Frankel分级,至末次随访2例由B级恢复至D级,1例由B级恢复至E级,3例由C级至D级,4例由C级至E级,13例由D级至E级。本组无内固定失败及假关节形成,所有患者均获得满意的植骨融合。结论:后路单侧椎板有限减压、病灶清除、椎间植骨融合内固定手术治疗伴椎管脓肿的胸椎脊柱结核创伤小,方法安全,临床疗效满意。更多还原

【Abstract】 Objective:To investigate the clinical efficacy and feasibility of surgical treatment for thoracic spinal tuberculosis with intraspinal abscesses by internal fixation,unilateral vertebral lamina limited decompression,debridement,together with interbody and posterior fusion via a posterior only approach.Methods:A total of 37 pantients(24 males and 13 females) with thoracic spinal tuberculosis complicated with intraspinal abscess lesions were admitted to our hospital,with age 13-68(39.7±9.l) years old.Spinal lesions of segmental kyphosis Cobb angle was 8°-62°(29.6°±3.6°).Frankel grade system was used to assess neurological function.According to the system,there were3,7,19 and 8 cases for grade B,C,D and E,respectively.All 37 cases were treated with internal fixation,unilateral vertebral lamina limited decompression,debridement,together with interbody and posterior fusion via a posterior only approach.Results:The mean duration for follow-up was 24-90(53.0±15.7) months.Intraoperative dural tear occurred in 1 cases with cerebrospinal fluid leakage after operation;2 cases showed postoperative neurological complications;delayed wound healing occurred in 2 cases.The postoperative kyphotic angle was 5°-21°(8.3°±1.3°).The kyphotic angle was 8°-26°(10.1°±1.9°) at the last follow-up.By the time of the last follow-up,all patients with preoperative neurological symptoms improved at different degree.According to Frankel classification,2 cases recovered from grade B to D,1 case from grade B to E,3 cases from grade C to D,4 cases from grade C to E,13 cases from grade D to E.No failure in fixation and pseudarthrosis.All patients obtained satisfactory bone graft fusion.Conclusion:Posterior internal fixation,unilateral vertebral lamina limited decompression,debridement,together with interbody and posterior fusion might be a effective and feasible method for treatment of thoracic spinal tuberculosis with intraspinal abscess lesions.更多还原