低位下頸椎前方入路聯合胸骨柄劈開術治療頸胸段脊柱結核_《華西醫學》

作者：

蔣成 , 葉俊武 , 蔚芃

川北醫學院附屬醫院骨科（四川南充，637000）;

關鍵詞：

脊柱結核頸胸段頸前方入路術

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【摘要】　目的　探討低位下頸椎前方入路聯合胸骨柄劈開術治療頸胸段脊柱結核的手術方式及術后療效。　方法　 2002年3月-2009年7月收治頸胸段脊柱結核16例，男11例，女5例；年齡18~52歲，平均38歲。其中位于頸6-胸1者2例，頸7-胸1者5例，胸1-2者4例，胸2-3者3例，胸1-3者2例。神經功能Frankel分級為：B級4例，C級7例，D級3例，E級2例。手術行低位下頸椎前方入路聯合胸骨柄劈開術，術中徹底清除結核肉芽組織、膿液、死骨并進行脊髓減壓，取自體髂骨塊植骨重建中前柱、前方鈦板內固定。術后佩戴頭頸胸支具6個月，正規抗癆18個月。術前后凸Cobb角為25~60°，平均為37.5°。　結果　全部患者均獲得隨訪，隨訪時間2~8年，平均3年。均獲得骨性融合，融合時間為5～8個月，無螺釘松動、脫落及鋼板斷裂等并發癥發生。神經功能恢復按Frankel分級，平均改善3.6個級別；結核病變無復發，術后后凸Cobb角明顯改善，為15～35°，平均22.6°，末次隨訪后凸角無明顯丟失。1例術后出現暫時性聲音嘶啞，術后1個月恢復。　結論　低位下頸椎前方入路聯合胸骨柄劈開術治療頸胸段脊柱結核，病灶顯露充分，植骨內固定，重建脊柱穩定性，矯正后凸畸形可靠。
【Abstract】　Objective　 To explore the clinical characteristics of cervico-thoracic junction spinal tuberculosis (CTJST) and to observe the therapeutic effect of lower anterior cervical approach combined with presternum-splitting approach on CTJST. 　Methods　 The clinical data of 16 patients with cervicothoracic junction spinal tuberculosis from Match 2002 to July 2008 were retrospectively analyzed. According to the Frankel grades, four patients were in grade B, seven were in grade C, three were in grade D, and two were in grade E. There were 11 males and five females with a average age of 38 years ranging from 18 to 52 years. All patients underwent radical excision of epidural granulation tissue/abscess and necrotic bone, whilst a proper tricortical iliac crest autograft and anterior titanium plate were placed to reconstruct the anteromedian spinal column, followed by chemotherapy for 18 months and immobilization in a brace for six months. The mean Cobb angle was 37.5° (ranged from 25° to 60°) before surgery.　Results　 All patients were followed up for two to eight years (three years on average), and got complete bone fusion within five to eight months postoperatively. There were no pull out and breakage of screws or plates.Spinal cord functional recovery improved on average 3.6 degree according Frankel standard, without recurrence of the disease or loss of Cobb angle till the last follow up. There was a statistically significant improvement in the Cobb angles from 22.6° to 37.5° (P lt;0.01) in average. However, two patients appeared transient hoarse voice after surgery, and the symptoms were alleviated one month after the operation.　Conclusion　 Lower anterior cervical approach combined with presternum-splitting approach for CTJST may provide adequate exposure to the lesion, keep the bone graft with internal fixation and spinal stability, and correct the kyphosis.

引用本文： 蔣成,葉俊武,蔚芃. 低位下頸椎前方入路聯合胸骨柄劈開術治療頸胸段脊柱結核. 華西醫學, 2010, 25(12): 2181-2184. doi: 復制

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2.	Godlwana L, Gounden P, Ngubo P, et al. Incidence and profile of spinal tuberculosis in patients at the only public hospital admitting such patients in KwaZulu-Natal [J]. Spinal Cord, 2008, 46(5): 372-374.
3.	Park DW, Sohn JW, Kim EH, et al. Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals [J]. Spine (Phila Pa 1976), 2007, 32(4): 130-135.
4.	Turgut M. Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome: a survey study on 694 patients[J]. Neurosurg Rev, 2001, 24(1): 8-13.
5.	Chunguang Z, Limin L, Rigao C, et al. Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis [J]. J Pediatr Orthop, 2010, 30(3): 271-276.
6.	Rajab TK, Barre LJ, et al. Back pain from spinal tuberculosis [J]. J Am Coll Surg, 2008, 207(3): 453.
7.	Sai Kiran NA, Vaishya S, Kale SS, et al. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients [J]. J Neurosurg Spine, 2007, 6(4): 320-326.
8.	Bakhsh A. Medical management of spinal tuberculosis: an experience from Pakistan [J]. Spine (Phila Pa 1976), 2010, 35(16): 787-791.
9.	Obaid ur Rahman, Ahmad S, Hussain T. Anterior surgical interventions in spinal tuberculosis [J]. J Coll Physicians Surg Pak, 2009, 19(8): 500-505.
10.	Zhao J, Lian XF, Hou TS, et al. Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly [J]. Int Orthop, 2007, 31(6): 859-863.
11.	Wang Z, Ge Z, Jin W, et al. Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae [J]. Spine J, 2007, 7(6): 671-681.
12.	秦世炳, 董偉杰, 徐雙錚. 脊柱結核藥物治療回顧性分析[J]. 第三軍醫大學學報, 2009, 31(20): 1929-1931.
13.	Boockvar JA, Philips MF, Telfeian AE, et al. Results and risk factors for anterior cervicothoracic junction surgery [J]. J Neurosurg, 2001, 94(Suppl 1): 12-17.
14.	Ebraheim NA, Lu J, Yang H, et al. Vulnerability of the sympathetic trunks during the anterior approach to the lower cervical spine [J]. Spine (Phila Pa 1976), 2000, 25(13): 1603-1606.
15.	Le Huec JC, Lesprit E, Guibaud JP, et al. Minimally invasive endoscopic approach to the cervicothoracic junction for vertebral metastases: report of two cases [J]. Eur Spine J, 2001, 10(5): 421-426.

1. 　Hsu LC, Leong JC. Tuberculosis of the lower cervicalspine (C2 to C7): a report of 40 cases [J]. J Bone Joint Surg (Br), 1984, 6 (1): 1-5.
2. 　Godlwana L, Gounden P, Ngubo P, et al. Incidence and profile of spinal tuberculosis in patients at the only public hospital admitting such patients in KwaZulu-Natal [J]. Spinal Cord, 2008, 46(5): 372-374.
3. 　Park DW, Sohn JW, Kim EH, et al. Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals [J]. Spine (Phila Pa 1976), 2007, 32(4): 130-135.
4. 　Turgut M. Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome: a survey study on 694 patients[J]. Neurosurg Rev, 2001, 24(1): 8-13.
5. 　Chunguang Z, Limin L, Rigao C, et al. Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis [J]. J Pediatr Orthop, 2010, 30(3): 271-276.
6. 　Rajab TK, Barre LJ, et al. Back pain from spinal tuberculosis [J]. J Am Coll Surg, 2008, 207(3): 453.
7. 　Sai Kiran NA, Vaishya S, Kale SS, et al. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients [J]. J Neurosurg Spine, 2007, 6(4): 320-326.
8. 　Bakhsh A. Medical management of spinal tuberculosis: an experience from Pakistan [J]. Spine (Phila Pa 1976), 2010, 35(16): 787-791.
9. 　Obaid ur Rahman, Ahmad S, Hussain T. Anterior surgical interventions in spinal tuberculosis [J]. J Coll Physicians Surg Pak, 2009, 19(8): 500-505.
10. 　Zhao J, Lian XF, Hou TS, et al. Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly [J]. Int Orthop, 2007, 31(6): 859-863.
11. 　Wang Z, Ge Z, Jin W, et al. Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae [J]. Spine J, 2007, 7(6): 671-681.
12. 　秦世炳, 董偉杰, 徐雙錚. 脊柱結核藥物治療回顧性分析[J]. 第三軍醫大學學報, 2009, 31(20): 1929-1931.
13. 　Boockvar JA, Philips MF, Telfeian AE, et al. Results and risk factors for anterior cervicothoracic junction surgery [J]. J Neurosurg, 2001, 94(Suppl 1): 12-17.
14. 　Ebraheim NA, Lu J, Yang H, et al. Vulnerability of the sympathetic trunks during the anterior approach to the lower cervical spine [J]. Spine (Phila Pa 1976), 2000, 25(13): 1603-1606.
15. 　Le Huec JC, Lesprit E, Guibaud JP, et al. Minimally invasive endoscopic approach to the cervicothoracic junction for vertebral metastases: report of two cases [J]. Eur Spine J, 2001, 10(5): 421-426.

《華西醫學》

低位下頸椎前方入路聯合胸骨柄劈開術治療頸胸段脊柱結核

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《華西醫學》

低位下頸椎前方入路聯合胸骨柄劈開術治療頸胸段脊柱結核

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