Autologous iliac bone graft and plate fixation in the repair of tuberculosis of the thoracic vertebra

doi:10.3969/j.issn.2095-4344.2014.35.006

Abstract

Abstract:

BACKGROUND: Thoracic vertebra connected to the corresponding section of the ribs constitute thoracic vertebral, which is deep, and the structure is complicated, so it is difficult to fully expose thoracic vertebrae. Usually, corresponding ribs is removed, and the injured site will be reached through thoracic cavity. The trauma is big. Some complications often occur such as chest pain, and local skin numbness. Therefore, whether it is possible to reach the same target without removal of ribs through intercostal space became a new clinical problem.
OBJECTIVE: To explore the safety and efficacy of autologous iliac bone graft and plate fixation for tuberculosis of thoracic vertebra.
METHODS: A total of 30 patients diagnosed with tuberculosis of thoracic vertebra from January 2008 to December 2013 were conventionally treated with anti-tuberculosis treatment for 2 to 3 weeks, and then treated with autologous iliac bone fusion through intercostal space and anterior plate fixation. Postoperative follow-up was conducted from 6 to 22 months. Fracture healing condition, the degree of pain relief, Cobb angle change, length of incision, blood loss, operation time, postoperative recovery of neurological function were observed.
RESULTS AND CONCLUSION: In 30 patients, the length of incision was (12.4±1.8) cm; longitudinal incision distraction width was (10±3.2) cm; the time of opening the chest was (16.0±2 .5) minutes; the time of closing the chest was (12.0±1.5) minutes; intraoperative blood loss amount was (430.0±87.4) mL. Preoperative and postoperative average kyphosis angles were respectively 27° and 8°, with an average rectification of 19°. The pain basically relieved at 1 to 2 weeks after the surgery. 28 patients were healed, and the symptoms of 2 patients were improved. Postoperative follow-up radiographs revealed that autologous bone grafts were thoroughly fused, and the fusion time lasted from 4 to 5 months. These data verified that autologous iliac bone graft through intercostal space and plate fixation is an effective, safe method for tuberculosis of thoracic vertebra. The exposed range through intercostal space can satisfy the operation requirements of complete tuberculosis clearance, autologous iliac bone graft and plate fixation, and can ensure the integrity of the whole thorax and spine stability.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: thoracic vertebrae, tuberculosis, internal fixators, ilium, bone transplantation

CLC Number:

R318

Huang Jiang, Yang Yuan, Lin Chun-bo, Li Xiao-feng . Autologous iliac bone graft and plate fixation in the repair of tuberculosis of the thoracic vertebra[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(35): 5606-5610.

Figures/Tables 1

2.1 参与者数量分析按意向性处理分析，纳入30例胸椎结核患者，全部进入结果分析，无脱落。 2.2 治疗结果本组30例患者，切口长度(12.4±1.8) cm，切口纵向撑开宽度(10.0±3.2) cm，二者比值约为1∶0.71；开胸时间(16.0±2 .5) min，关胸时间(12.0±1.5) min；术中出血量(430.0±87.4) mL，术后术区引流量(280.0±28.7) mL；卧床时间(7±1) d，疼痛时间(5±2) d，平均住院(10±2) d。与单纯一期后路病灶清除椎体间植骨融合内固定治疗胸椎结核的临床研究相比较[9]，可见经肋间隙入路在手术时间、平均出血量及卧床时间方面表现得更好。术后一至两周背部疼痛基本缓解，术后5-8周血沉基本正常。无严重手术并发症，切口均一期愈合，术后1周目测类比评分平均为8.3分。30例患者中28例痊愈，2例好转。本组后凸畸形角度术前平均27°，术后平均8°，平均矫正19°。 2.3 随访结果术后随访6-22个月，无复发病例；5例合并脊髓损伤患者，术后1年神经功能完全恢复。术后X射线片显示病灶植骨全部融合，融合时间为四至五个月。术后 6-12个月复查胸椎X射线片，后凸矫正无明显丢失。 2.4 典型病例男性患者，51岁，胸背疼痛1年，加重6个月。于2012年1月入院，术前诊断为T8椎体结核伴椎旁脓肿形成。给予三联抗结核治疗3周，血沉、C-反应蛋白均基本恢复正常。入院时疼痛目测类比评分为7分，Cobb角约26°。在插管全麻下行经肋间隙入路胸椎结核一期病灶清除、植骨融合、前路钢板置入内固定，术后12个月椎间植骨块按Bridwell标准达Ⅰ级骨性愈合。Cobb角明显改善，内固定无松动(图1)。 2.5 不良事件 2例胸膜粘连患者因撑开过快导致一肋骨骨折，经缝合内固定8周后愈合。其余病例胸廓外观无畸形，胸腹壁皮肤感觉无异常。"

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