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目的探讨后路椎弓根固定联合前路开胸病灶清除治疗儿童胸椎结核的疗效。方法搜集首都医科大学附属北京胸科医院2004年1月至2010年12月采用后路椎弓根固定联合前路开胸病灶清除治疗儿童胸椎结核35例,其中有13例合并不同程度瘫痪,1例合并尿潴留。术后随访1～7年,平均3.5年,对患者局部病灶有无复发、症状改善情况,以及后凸畸形矫正的近期和远期变化情况进行分析。结果35例患者均得到结核病临床治愈,未发现复发;13例合并不同程度瘫痪者下肢肌力均提高1～3级;1例尿潴留患者于术后5个月恢复排尿功能;35例患者术前平均后凸Cobb角为42°(20°～55°),术后近期平均为22°(5°～38°),术后随访1～7年(平均3.5年),后凸Cobb角仍平均为22°(5°～40°),其中17例于术后2～3年取出内固定。结论后路椎弓根固定联合前路开胸病灶清除治疗儿童胸椎结核能够一期完成病灶清除,脊髓减压彻底,提供肋骨植骨,重建脊柱稳定性,有效矫正后凸畸形,预防远期后凸畸形加重。
Objective To investigate the effect of posterior pedicle screw fixation combined with anterior open thoracotomy for the treatment of thoracic tuberculosis in children. Methods Thirty-five children with thoracic tuberculosis were treated with pedicle screw fixation and anterior thoracotomy in the Beijing Chest Hospital affiliated to Capital Medical University from January 2004 to December 2010. Thirteen cases were complicated with paralysis of varying degrees Cases of urinary retention. The patients were followed up for 1 to 7 years with an average of 3.5 years. The patients were analyzed for the presence or absence of local recurrence, the improvement of symptoms and the short-term and long-term changes of kyphosis deformity. Results Thirty-five patients were clinically cured of tuberculosis and no recurrence was found. Thirteen patients with varying degrees of paralysis experienced an increase in grade 1 to 3 of lower extremity muscular strength. One patient with urinary retention regained urination function at 5 months after operation. 35 patients The mean kyphotic Cobb angle was 42 ° (20 ° ~ 55 °) and the average postoperative short-term angle was 22 ° (5 ° -38 °). Follow-up was performed for 1-7 years (mean, 3.5 years) Average 22 ° (5 ° ~ 40 °), of which 17 cases were removed after 2 to 3 years of internal fixation. Conclusion Posterior pedicle screw fixation combined with anterior open thoracotomy for the treatment of thoracic tuberculosis in children can complete the lesion in one stage, completely decompress the spinal cord, provide rib bone graft, reconstruct the spinal column, correct the kyphosis and prevent long-term Deformity increased.