The clinical research of axillary midline transthoracic approach for the upper and middle thoracic tuberculosis
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摘要:
目的探讨经腋中线胸腔入路治疗上中胸椎结核的临床研究。 方法于2010年8月~2014年9月采用经腋中线胸腔病灶清除减压植骨内固定治疗上中胸椎结核患者，男13例，女8例。年龄33~77岁，平均45.5岁。所有患者均有结核中毒症状，胸椎后凸畸形。17例有神经压迫症状。 结果随访期内所有患者愈合良好，术后1例出现术区疼痛、麻木，经治疗后缓解。21例患者获得随访15~30个月，平均20.8个月。胸椎后凸角平均矫正1.58°。疼痛视觉模拟评分(VAS)平均改善4.14分，血沉均恢复正常。17例有神经系统症状的患者均有不同程度的恢复。 结论经腋中线胸腔入路可以达到治疗上中胸椎结核的目的。 Abstract:Objective To explore the curative effect of axillary midline transthoracic approach for treatment of upper and middle thoracic tuberculosis. Methods 21 patients with upper and middle thoracic tuberculosis underwent one-stage debridement and bone grafting with internal fixation via axillary midline transthoracic approach. There are 13 men and 8 women aging 35 to 77 year-old, with the average age of 45.5 years old. All patients had various degrees with tuberculosis poisoning symptoms and thoracic kyphotic deformity. Seventeen of the patients have different degrees of nerve compression symptoms. Results All patients recover well during the follow-up period. 1 case got pain, numbness in surgical site after operation, but rapidly alleviated after the treatment. 21 patients were followed from 15 to 30 months, with the average period of 20.8 months. The kyphosis Cobb's angle corrected with the average angle of 1.58° , visual analogue scale (VAS) have improvement with an average score of 4.14. And at the last follow-up, those 17 cases of patients with neurological symptoms impoved in varying degrees. Erythrocyte sedimentation rate (ESR) declined in varying degrees. Conclusions Axillary midline transthoracic approach can achieve the goal of treatment of upper and middle thoracic tuberculosis. -
图 1 术前CT与MRI检查结果
Figure 1. The results of preoperative CT and MRI.A: preoperativeCT; B: preoperative MRI.
图 2 术后X线与CT检查结果
Figure 2. The results of postoperative ofX-ray and CT
A: Postoperative X-ray; B-C: X-rayand CT after 3 months; D-E: X-rayand CT after 2 years and a half.
表 1 术前与术后各项评估指标对比
Table 1. The ratio of preoperative and postoperative indexes（Mean±SD, n=21）
Groups VAS (score) Kyphosis Cobb's angle (°) ESR (mm/h) Preoperative 5.62±1.16 26.68±6.34° 38.90±16.08 Three months after operation 1.47±1.03 25.13±6.40° 24.38±4.26 Difference 4.14±1.27 1.58±0.58° 2.67±1.24 
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表 2 术前与术后随访神经功能情况对比(Frankel分级)
Table 2. The ratio of preoperative and postoperative neural function（Frankel classification）
Groups Preoperative cases Cases of 1 year after the operation Cases of the last follow-up after the operation Grade A 1 0 0 Grade B 2 0 0 Grade C 10 1 0 Grade D 4 8 9 Grade E 4 12 12 Total 21 21 21
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