肩胛骨下胸腔入路治疗上胸椎结核

摘要

Objective To explore clinical value of the therapeutic effect of subscapularis transthoracic approach for upper thoracic tuberculosis. Methods A total of 21 patients with upper thoracic tuberculosis underwent the subscap-ularis transthoracic,debridement,bony fusion and internal fixation. Results The operation time was ranged 152 ~238 (192 ± 10) min. The blood loss was ranged 600 ~1 800 (1 150 ± 235) ml. The follow-up time was 6 ~48 months. 2 cases were complicated with shoulder joint dysfunction after rehabilitation treatment,and returned to normal shoulder joint activity after follow-up about 6 months. 2 cases were complicated with lung infection. It had been cured after 10 days by anti-infection therapy. At last follow-up, there were 17 patients with spinal cord injury,Frankel scale improved by 1 case,16 cases of nerve function were recovered to normal. The kyphosis Cobb angles were 19° ~30° (24. 8° ± 5. 6°) after operation,with an average correction rate of 30. 9%. Conclusions Posterior debridement,bony graft and instrumentation is reliable and safe for upper thoracic tuberculosis underwent the subscapularis transthorac-ic,which has higher clinical value.%目的 探讨肩胛骨下胸腔入路手术治疗上胸椎结核的临床价值. 方法 对21例上胸椎结核患者采用肩胛骨下经胸手术病灶清除、植骨融合、内固定治疗. 结果 手术时间为152~238 ( 192 ± 10 ) min;术中出血量600~1 800(1 150 ± 235)ml. 患者均获随访,时间6~48个月.2例术后出现肩关节活动障碍,经康复治疗,随访6个月后患者肩关节活动基本正常;2例术后出现肺部感染,抗感染治疗10 d后治愈. 末次随访时, 17例脊髓神经功能损伤者中,1例神经功能明显改善,16 例神经功能均恢复至正常. 术后Cobb角为19° ~30° (24. 8° ± 5. 6°),矫正率达30. 9%. 结论 只要严格掌握手术适应证,肩胛骨下经胸内固定术治疗上胸椎结核减压彻底,脊柱稳定重建可靠,疗效肯定,具有较大临床价值.