• 中南大學(xué)湘雅醫(yī)院脊柱外科（長(zhǎng)沙，410008）;

目的 探討在一期后路病灶清除、植骨融合內(nèi)固定基礎(chǔ)上，采用有限減壓、硬膜囊外可吸收性止血綾覆蓋及椎板重建治療單節(jié)段胸椎結(jié)核的療效。 方法回顧分析2005年9月－2010年3月收治的90例單節(jié)段胸椎結(jié)核患者臨床資料，其中對(duì)照組46例采取一期后路病灶清除、植骨融合內(nèi)固定治療，治療組44例在此基礎(chǔ)上聯(lián)合有限減壓、硬膜囊外可吸收性止血綾覆蓋及椎板重建治療。兩組患者性別、年齡、病程、病變節(jié)段、術(shù)前Cobb角、Frankel分級(jí)、紅細(xì)胞沉降率（erythrocyte sedimentation rate，ESR）、Oswestry功能障礙指數(shù)（ODI）等一般資料比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。 結(jié)果術(shù)后患者切口均Ⅰ期愈合。90例均獲隨訪，隨訪時(shí)間24～44個(gè)月，平均38個(gè)月。術(shù)后1周及3個(gè)月兩組ESR比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。影像學(xué)檢查示，治療組植骨均融合，硬膜外未見(jiàn)明顯瘢痕組織，無(wú)內(nèi)固定失效，對(duì)照組出現(xiàn)3例內(nèi)固定失效，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P=0.032）。兩組術(shù)后Cobb角均較術(shù)前顯著改善（P  lt; 0.05）；治療組術(shù)后2年及末次隨訪時(shí)Cobb角及其矯正丟失度均優(yōu)于對(duì)照組（P  lt; 0.05）。末次隨訪時(shí)兩組ODI均較術(shù)前顯著改善（P  lt; 0.05），且治療組ODI及其改善率均優(yōu)于對(duì)照組（P  lt; 0.05）。末次隨訪時(shí)兩組Frankel分級(jí)均較術(shù)前顯著改善（P  lt; 0.05），且治療組優(yōu)于對(duì)照組（Uc=4.368，P=0.000）。 結(jié)論與傳統(tǒng)手術(shù)方法比較，一期后路有限減壓、病灶清除、植骨融合內(nèi)固定聯(lián)合硬膜囊外可吸收性止血綾覆蓋及椎板重建，具有創(chuàng)傷小、并發(fā)癥少及患者術(shù)后功能恢復(fù)佳等特點(diǎn)，是治療單節(jié)段胸椎結(jié)核的一種有效手術(shù)方法。

引用本文： 羅一,鄧展生,陳靜,郭超峰. 有限減壓及椎板重建在單節(jié)段胸椎結(jié)核手術(shù)治療中的應(yīng)用. 中國(guó)修復(fù)重建外科雜志, 2012, 26(12): 1409-1414. doi: 復(fù)制

1. Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine—A classification based on the selection of surgical strategies. J Bone Joint Surg (Br), 2001, 83(6): 859-863.
2. Garg B, Kandwal P, Nagaraja UB, et al. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian J Orthop, 2012, 46(2): 165-170.
3. 王自立. 對(duì)徹底治愈脊柱結(jié)核病灶及其相關(guān)問(wèn)題的管見(jiàn). 中國(guó)脊柱脊髓雜志, 2008, 18(8): 568-570.
4. Ma C, Wu S, Xiao L, et al. Responsiveness of the Chinese version of the Oswestry disability index in patients with chronic low back pain. Eur Spine J, 2011, 20(3): 475-481.
5. 劉進(jìn), 劉浩, 李濤, 等. 單節(jié)段Coflex棘突間動(dòng)力重建與后路360°植骨融合治療腰椎退變性疾病的對(duì)比研究. 中國(guó)修復(fù)重建外科雜志, 2011, 25(6): 693-698.
6. Reinhold M, Knop C, Beisse R, et al. Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Unfallchirurg, 2009, 112(1): 294-316.
7. 文永強(qiáng), 詹偉彥, 何開正, 等. 有限潛行減壓術(shù)治療多節(jié)段腰椎間盤突出癥療效分析. 中國(guó)修復(fù)重建外科雜志, 2006, 20(4): 407-409.
8. Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
9. Wurgler-Hauri CC, Kalbarczyk A, Wiesli M, et al. Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine (Phila Pa 1976), 2008, 33(3): E66-72.
10. Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop, 2012, 36(2): 299-305.
11. Xie JM, Li T, Wang YS, et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J, 2012, 21(4): 705-710.
12. Hsu WH, Lui TN, Chang CN, et al. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteoporotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci, 2011, 18(12): 1645-1650.
13. Bokov A, Istrelov A, Skorodumov A, et al. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician, 2011, 14(6): 545-557.
14. Chandler K, Cappello R. Laminectomy membrane formation in dogs: Is the answer still elusive? Vet J, 2006, 172(1): 1-2.
15. Hollingworth W, Turner JA, Welton NJ, et al. Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers’ compensation population. Spine (Phila Pa 1976), 2011, 36(24): 2076-2083.
16. 張宇, 周初松, 蔣剛彪, 等. 殼聚糖/聚乙二醇琥珀酸酯/絲裂霉素C釋藥系統(tǒng)預(yù)防椎板切除術(shù)后硬脊膜外瘢痕粘連的實(shí)驗(yàn)研究. 中國(guó)修復(fù)重建外科雜志, 2008, 22(10): 1222-1226.
17. 龐祖才, 許漢權(quán), 謝偉堅(jiān), 等. 預(yù)防椎板切除術(shù)后硬膜外粘連的實(shí)驗(yàn)研究. 中國(guó)修復(fù)重建外科雜志, 2006, 20 (12): 1176-1179.
18. 黃俊俊, 宋躍明, 劉立岷, 等. 聚乳酸薄膜預(yù)防腰椎間盤突出癥術(shù)后硬膜外粘連的臨床研究. 中國(guó)修復(fù)重建外科雜志, 2004, 18(1): 21-24.
19. Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J, 2009, 18(8): 1202-1212.
20. 劉華春. 椎板切除術(shù)應(yīng)用泰綾預(yù)防硬膜外瘢痕粘連. 中國(guó)當(dāng)代醫(yī)藥, 2011, 18(21): 187, 190.
21. 唐欣, 楊述華, 李寶興, 等. 同種異體骨板覆蓋預(yù)防硬膜外瘢痕粘連的實(shí)驗(yàn)研究. 中國(guó)修復(fù)重建外科雜志, 2006, 20(8): 816-819.
22. Wee JH, Lee CH, Rhee CS, et al. Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhinolaryngol, 2012, 269(3): 897-903.
23. Zhang H, Huang S, Guo H, et al. A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only. Int Orthop, 2012, 36(2): 293-298.
  1. 1. Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine—A classification based on the selection of surgical strategies. J Bone Joint Surg (Br), 2001, 83(6): 859-863.
  2. 2. Garg B, Kandwal P, Nagaraja UB, et al. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian J Orthop, 2012, 46(2): 165-170.
  3. 3. 王自立. 對(duì)徹底治愈脊柱結(jié)核病灶及其相關(guān)問(wèn)題的管見(jiàn). 中國(guó)脊柱脊髓雜志, 2008, 18(8): 568-570.
  4. 4. Ma C, Wu S, Xiao L, et al. Responsiveness of the Chinese version of the Oswestry disability index in patients with chronic low back pain. Eur Spine J, 2011, 20(3): 475-481.
  5. 5. 劉進(jìn), 劉浩, 李濤, 等. 單節(jié)段Coflex棘突間動(dòng)力重建與后路360°植骨融合治療腰椎退變性疾病的對(duì)比研究. 中國(guó)修復(fù)重建外科雜志, 2011, 25(6): 693-698.
  6. 6. Reinhold M, Knop C, Beisse R, et al. Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Unfallchirurg, 2009, 112(1): 294-316.
  7. 7. 文永強(qiáng), 詹偉彥, 何開正, 等. 有限潛行減壓術(shù)治療多節(jié)段腰椎間盤突出癥療效分析. 中國(guó)修復(fù)重建外科雜志, 2006, 20(4): 407-409.
  8. 8. Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
  9. 9. Wurgler-Hauri CC, Kalbarczyk A, Wiesli M, et al. Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine (Phila Pa 1976), 2008, 33(3): E66-72.
  10. 10. Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop, 2012, 36(2): 299-305.
  11. 11. Xie JM, Li T, Wang YS, et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J, 2012, 21(4): 705-710.
  12. 12. Hsu WH, Lui TN, Chang CN, et al. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteoporotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci, 2011, 18(12): 1645-1650.
  13. 13. Bokov A, Istrelov A, Skorodumov A, et al. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician, 2011, 14(6): 545-557.
  14. 14. Chandler K, Cappello R. Laminectomy membrane formation in dogs: Is the answer still elusive? Vet J, 2006, 172(1): 1-2.
  15. 15. Hollingworth W, Turner JA, Welton NJ, et al. Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers’ compensation population. Spine (Phila Pa 1976), 2011, 36(24): 2076-2083.
  16. 16. 張宇, 周初松, 蔣剛彪, 等. 殼聚糖/聚乙二醇琥珀酸酯/絲裂霉素C釋藥系統(tǒng)預(yù)防椎板切除術(shù)后硬脊膜外瘢痕粘連的實(shí)驗(yàn)研究. 中國(guó)修復(fù)重建外科雜志, 2008, 22(10): 1222-1226.
  17. 17. 龐祖才, 許漢權(quán), 謝偉堅(jiān), 等. 預(yù)防椎板切除術(shù)后硬膜外粘連的實(shí)驗(yàn)研究. 中國(guó)修復(fù)重建外科雜志, 2006, 20 (12): 1176-1179.
  18. 18. 黃俊俊, 宋躍明, 劉立岷, 等. 聚乳酸薄膜預(yù)防腰椎間盤突出癥術(shù)后硬膜外粘連的臨床研究. 中國(guó)修復(fù)重建外科雜志, 2004, 18(1): 21-24.
  19. 19. Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J, 2009, 18(8): 1202-1212.
  20. 20. 劉華春. 椎板切除術(shù)應(yīng)用泰綾預(yù)防硬膜外瘢痕粘連. 中國(guó)當(dāng)代醫(yī)藥, 2011, 18(21): 187, 190.
  21. 21. 唐欣, 楊述華, 李寶興, 等. 同種異體骨板覆蓋預(yù)防硬膜外瘢痕粘連的實(shí)驗(yàn)研究. 中國(guó)修復(fù)重建外科雜志, 2006, 20(8): 816-819.
  22. 22. Wee JH, Lee CH, Rhee CS, et al. Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhinolaryngol, 2012, 269(3): 897-903.
  23. 23. Zhang H, Huang S, Guo H, et al. A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only. Int Orthop, 2012, 36(2): 293-298.