关键词: 植入物, 脊柱植入物, 胸椎结核, 椎体切除, 后入路, 内固定, 植骨融合, 椎弓根钉棒系统, 脊柱生理曲度, 脊柱稳定性

Abstract:

BACKGROUND: The commonly used way to treat thoracic tuberculosis is anterior or anterior plus posterior debridement, bone grafting and internal fixation, which has been used for decades. But this operation has some limitations, such as large trauma, rib resection, incomplete decompression, postoperative pain, pneumothorax, thorax and lung infection.
OBJECTIVE: To observe the follow-up outcomes of titanium mesh autogenous bone grafting combined with pedicle screw internal fixation in repair of thoracic spinal tuberculosis and reconstruction of spinal physiological curvature and stability.
METHODS: 32 patients of thoracic tuberculosis were treated by posterior vertebral resection, release of spinal cord compression, titanium mesh autologous bone grafting, and pedicle screw internal fixation. A posterior midline incision was made, covering two vertebral segments at the cephalic and caudal ends, bilateral vertebral plate was exposed until the small joints and 1.0-2.0 cm lateral to the proximal rib. Pedicle screws were implanted into the cephalic and caudal ends of the affected vertebra, two pairs in each end, and were fixed. The vertebral lamina, articular process, rib bone at the contralateral side and the next vertebra were resected, followed by free nerve root and spinal canal decompression. The spinal cord and nerve root should be protected during surgery. The vertebral abscess was sucked out. Pedicle of vertebral arch, intervertebral disk lesions and vertebral body lesions were resected, until normal edge of surrounding tissue, no dead bone, no tuberculosis substances and granulation tissue were visible. As for patients with severe vertebral damage and many vertebral abscess that cannot be completely removed by one-side debridement, we suggested decompression and pedicle screws or robs, to maintain temporary stability of the vertebral bodies upon the resection. Using the same methods, we completely removed the lesions at the contralateral side, completely free spinal dura mater, and repeated washed it. The bone graft fusion time, fracture healing time, neurological function recovery and complications were observed.
RESULTS AND CONCLUSION: The involved patients were followed up for 12-38 months and all patients achieved bone graft fusion at postoperative 11 to 19 months (average 16.3 months). 70%-100% (average 86.3%) of kyphosis cases were corrected. Spinal cord functions returned to normal, and no internal fixation failure and recurrence occurred. Experimental findings indicate that, one-stage radical debridement, titanium mesh autologous bone grafting, and pedicle screw internal fixation via posterior approach is an effective treatment of thoracic spinal tuberculosis, due to complete removal of the lesions, few trauma, deformity correction and satisfactory bone graft fusion.

Key words: spinal cord fusion, kyphosis deformity, tuberculosis, spinal, internal fixators