Objective: To investigate the effectiveness of bundled multi-segment autologous rib graft reconstruction for bone defects after thoracic spinal tuberculosis debridement.
Methods: The anterior debridement, multi-segment autologous rib interbody fusion, anterior or posterior internal fixation were used for treating the bone defect after thoracic spinal tuberculosis debridement in 36 cases between January 2006 and December 2013. There were 20 males and 16 females with an average age of 50.5 years (range, 21-60 years), and an average disease duration of 6.8 months (range, 5-11 months). The thoracic vertebral tuberculosis located at T 4, 5 in 1 case, T 5, 6 in 4 cases, T 6, 7 in 4 cases, T 7, 8 in 4 cases, T 8, 9 in 9 cases, T 9, 10 in 8 cases, T 10, 11 in 5 cases, and T 11, 12 in 1 case. Neurological impairment of 34 patients was assessed as grade B in 2 cases, grade C in 8 cases, and grade D in 24 cases according to Frankel classification. The pre- and post-operative erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS) score, and kyphosis Cobb angle were evaluated. The fusion rate was analysed based on CT three-dimensional reconstruction.
Results: The cross-sectional area of the bundled multi-segment rib graft was 136.8-231.2 mm 2 (mean, 197.1 mm 2); the endplate surface area of adjacent upper and lower vertebral bodies was 425.0-677.6 mm 2 (mean, 550.6 mm 2); and the cross-sectional area of rib graft accounted for 29%-50% (mean, 33.6%) of the endplate surface area. The operation time was 95-160 minutes (mean, 125 minutes) and the intraopeartive blood loss was 280-850 mL (mean, 450 mL). All the patients were followed up 2-8 years (mean, 4.4 years). The postoperative complications included intercostals neuralgia in 2 cases, pleural effusion in 1 case, and liver function damage caused by antituberculosis drugs in 2 cases, who were all cured after symptomatic treatment. The rest patients had no respiratory complications and wound infection; and there was no fracture, displacement, absorption of rib support, tuberculosis recurrence, internal fixation loosening, and kyphosis occurred in all patients. CT three-dimensional reconstruction showed that the fusion rate was 86.1 (31/36) at 6 months after operation and was 97.2% (35/36) at 12 months after operation. The ESR, CRP, VAS scores, and kyphosis Cobb angle at 3 months after operation and last follow-up were significantly improved when compared with preoperative values ( P<0.05), but there was no significant difference between at 3 months after operation and last follow-up ( P>0.05). Neurological deficits were all improved at last follow-up according to Frankel classificaiton, including 2 cases with grade B recovered to grade D, 8 cases with grade C to grade D in 1 case and to grade E in 7 cases, 24 cases with grade D all to grade E.
Conclusion: Bundled multi-segment autologous rib graft reconstruction is an alternative method for less than 2 discs and vertebral bone defect created by radical debridement for thoracic spinal tuberculosis.
目的: 探讨自体肋骨捆绑移植重建治疗胸椎结核病灶清除术后骨缺损的疗效。.
方法: 2006 年 1 月—2013 年 12 月，采用前路病灶清除、捆绑肋骨椎间植骨融合，前路或后路内固定术治疗 36 例胸椎结核术后骨缺损。男 20 例，女 16 例；年龄 21～60 岁，平均 50.5 岁。病程 5～11 个月，平均 6.8 个月。胸椎结核位于 T 4、5 1 例，T 5、6 4 例，T 6、7 4 例，T 7、8 4 例，T 8、9 9 例，T 9、10 8 例，T 10、11 5 例，T 11、12 1 例。伴神经损害 34 例，根据 Frankel 分级为 B 级 2 例、C 级 8 例、D 级 24 例。记录患者手术前后红细胞沉降率（erythrocyte sedimentation rate，ESR）、C 反应蛋白（C reactive protein，CRP）、疼痛视觉模拟评分（VAS）及胸椎后凸 Cobb 角；根据 CT 三维重建分析植骨融合情况。.
结果: 术后测量捆绑肋骨的横截面积为136.8～231.2 mm 2，平均 197.1 mm 2；相邻上、下位椎体终板表面积为 425.0～677.6 mm 2，平均 550.6 mm 2；肋骨占终板表面积百分比为 29%～50%，平均 33.6%。手术时间 125～160 min，平均 125 min；术中出血量 280～850 mL，平均 450 mL。患者均获随访，随访时间 2～8 年，平均 4.4 年。术后出现肋间神经痛 2 例、胸腔积液 1 例、结核药物导致肝功能损害 2 例，均经对症治疗后治愈。其余患者未发生任何呼吸道并发症及伤口感染，无肋骨支撑体骨折、移位和吸收，无结核病灶复发，无内固定物松动断裂、脊柱后凸畸形。术后 6 个月三维 CT 示融合率为 86.1%（31/36），术后 12 个月为 97.2%（35/36）。术后 3 个月及末次随访时 ESR、CRP、VAS 评分及胸椎后凸 Cobb 角均较术前显著改善（ P<0.05），术后 3 个月及末次随访间比较差异无统计学意义（ P>0.05）。术前 Frankel 分级 B 级 2 例均恢复至 D 级，术前 C 级 8 例恢复至 D 级 1 例、E 级 7 例，术前 D 级 24 例均恢复至 E 级。.
结论: 对中下胸椎结核病灶清除术后小于 2 个椎体和椎间盘的骨缺损，采用自体肋骨捆绑支撑移植是可行的。.
Keywords: Thoracic tuberculosis; debridement; internal fixation; rib graft.