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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,矫形效果显著,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。
Objective: To investigate the effect of stage I surgery for the treatment of thoracic tuberculosis in children with posterior tuberculosis removal and bone graft fusion and internal fixation. Methods: From June 2005 to December 2010, 9 cases of pediatric thoracic tuberculosis were treated with debridement, bone graft fusion and internal fixation, including 7 males and 2 females, aged 3 to 12 years (average 7 years old) 1 year, an average of 6 months. Children with varying degrees of chest pain, intercostal neuralgia and kyphosis, accompanied by fever, night sweats, weight loss and other systemic symptoms. Preoperative X-ray, CT, MRI examination showed that lesions occurred in T4-T9 segment. Thoracic kyphotic angle 35 ° ~ 72 °, an average of 48.2 °. Preoperative spinal cord function ASIA classification: B grade in 2 cases, C grade in 5 cases, D grade in 2 cases. Postoperative X-ray film regularly to understand changes in kyphosis and interbody fusion, using ASIA grading postoperative recovery of spinal cord function. Results: No intraoperative blood vessels or spinal cord injury were followed up for 16 to 38 months with an average of 24 months. All children with tuberculosis symptoms disappeared, no tuberculosis recurrence, incision infection, sinus formation or internal fixation failure and other complications, review of normal erythrocyte sedimentation rate. 4 to 8 months after X-ray examination showed intervertebral bone all received bone healing, internal fixation position. After the last follow-up, the angle of lobe was 12 ° ~ 30 ° with an average of 19.5 °. ASIA classification of spinal cord function included 2 cases of C grade, 2 cases of D grade and 5 cases of E grade. Spinal cord function improved to varying degrees. Conclusion: The complete removal of thoracic tuberculosis, the reliable decompression of vertebral canal, and the significant effect of orthopedic surgery were achieved in posterior approach. The stability of thoracic spine can be effectively reconstructed with autologous or allograft bone screw system.