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目的:探讨后前路手术治疗儿童胸腰椎结核的效果,并观察病椎间或超病椎间固定时相邻节段(未施行融合术)自发融合的发生情况。方法:2000年4月~2011年5月采用后前路手术方式治疗并获得完整随访资料的儿童胸腰椎结核患者23例,其中男11例,女12例,平均年龄11.2±0.6岁(7~14岁)。所有患者均有不同程度的椎体破坏及后凸畸形;21例有脓肿形成;8例合并神经功能障碍(Frankel分级C级3例,D级5例)。手术方法为后路病椎间或超病椎间椎弓根螺钉内固定、病椎间后外侧植骨融合,前路彻底病灶清除、减压、病椎间髂骨支撑植骨融合。病椎间固定(病变未累及椎弓根者)17例,超病椎间固定6例,术后均行超短程化疗。对患者后凸角、血沉及C-反应蛋白的变化情况、植骨融合情况、Frankel分级等进行综合评价。结果:所有患者术后平均随访68.43±23.40个月(36~120个月)。所有患者的血沉及C-反应蛋白在术后6个月均恢复正常。前中柱植骨愈合时间平均4.26±0.81个月。病椎间固定者,后凸畸形矫正率(72±5)%,末次随访丢失1.29°±0.85°;病变共累及28个节段,固定融合28个节段,末次随访共30个节段的小关节融合,自发性融合2个节段。超病椎间固定者,后凸畸形矫正率(77±6)%,末次随访丢失1.00°±1.10°;病变共累及10个节段,固定22个节段,手术融合10个节段,末次随访共25个节段的小关节融合,自发性融合15个节段。8例神经功能障碍者末次随访时Frankel分级均达到E级。结论:后前路手术治疗儿童胸腰椎结核疗效优良,病变未累及椎弓根者采用病椎间固定可以减少未施行融合的相邻节段自发融合的发生。
Objective: To explore the effect of anterior approach surgery for thoracolumbar tuberculosis in children and to observe the spontaneous fusion of adjacent segments (without fusion) during intervertebral fixation or intervertebral fixation. METHODS: Twenty-three children with thoracolumbar tuberculosis who underwent anterior anterior approach and were followed up from April 2000 to May 2011 were retrospectively reviewed. Among them, 11 were males and 12 were females, with a mean age of 11.2 ± 0.6 years (range, 14 years old). All patients had varying degrees of vertebral body destruction and kyphosis; 21 cases had abscess formation; 8 cases had neurological dysfunction (Frankel Grade C 3 cases, Grade D 5 cases). Surgical methods for the posterior interosseous or super-disease intervertebral pedicle screw fixation, intervertebral posterolateral fusion, anterior thorough debridement, decompression, interspinous iliac bone graft fusion. Intervertebral fixation (lesion not involving the pedicle) in 17 cases, super-disease intervertebral fixation in 6 cases, postoperative ultra-short-range chemotherapy. Patients with kyphosis, erythrocyte sedimentation rate and C-reactive protein changes, bone fusion, Frankel grading and other comprehensive evaluation. Results: All patients were followed up for an average of 68.43 ± 23.40 months (36 to 120 months). ESR and C-reactive protein in all patients returned to normal after 6 months. The mean time of bone graft healing was 4.26 ± 0.81 months. The correction rate of kyphosis was (72 ± 5)% in the intervertebral fixation group and 1.29 ° ± 0.85 ° in the last follow-up. The lesion involved 28 segments and fixedly fused 28 segments with the final follow-up of 30 segments Small joint fusion, spontaneous fusion of two segments. The correction rate of kyphosis was (77 ± 6)% in the patients with superficial intervertebral fixation, and 1.00 ° ± 1.10 ° in the last follow-up. The lesions involved 10 segments and fixed 22 segments. The segments fused 10 segments at the last time Followed up a total of 25 segments of facet joint fusion, spontaneous fusion of 15 segments. Eight cases of neurological dysfunction at the last follow-up Frankel grading reached E grade. Conclusion: The anterior approach for the treatment of thoracic and lumbar tuberculosis in children with excellent curative effect, the lesion does not involve the pedicle of intervertebral fixation can reduce the occurrence of spontaneous fusion of adjacent segments without fusion.