【摘要】　目的　 探讨低位下颈椎前方入路联合胸骨柄劈开术治疗颈胸段脊柱结核的手术方式及术后疗效。　方法　 2002年3月-2009年7月收治颈胸段脊柱结核16例，男11例，女5例；年龄18~52岁，平均38岁。其中位于颈6-胸1者2例，颈7-胸1者5例，胸1-2者4例，胸2-3者3例，胸1-3者2例。神经功能Frankel分级为：B级4例，C级7例，D级3例，E级2例。手术行低位下颈椎前方入路联合胸骨柄劈开术，术中彻底清除结核肉芽组织、脓液、死骨并进行脊髓减压，取自体髂骨块植骨重建中前柱、前方钛板内固定。术后佩戴头颈胸支具6个月，正规抗痨18个月。术前后凸Cobb角为25~60°，平均为37.5°。　结果　 全部患者均获得随访，随访时间2~8年，平均3年。均获得骨性融合，融合时间为5～8个月，无螺钉松动、脱落及钢板断裂等并发症发生。神经功能恢复按Frankel分级，平均改善3.6个级别；结核病变无复发，术后后凸Cobb角明显改善，为15～35°，平均22.6°，末次随访后凸角无明显丢失。1例术后出现暂时性声音嘶哑，术后1个月恢复。　结论　 低位下颈椎前方入路联合胸骨柄劈开术治疗颈胸段脊柱结核，病灶显露充分，植骨内固定，重建脊柱稳定性，矫正后凸畸形可靠。
【Abstract】　Objective　 To explore the clinical characteristics of cervico-thoracic junction spinal tuberculosis (CTJST) and to observe the therapeutic effect of lower anterior cervical approach combined with presternum-splitting approach on CTJST. 　Methods　 The clinical data of 16 patients with cervicothoracic junction spinal tuberculosis from Match 2002 to July 2008 were retrospectively analyzed. According to the Frankel grades, four patients were in grade B, seven were in grade C, three were in grade D, and two were in grade E. There were 11 males and five females with a average age of 38 years ranging from 18 to 52 years. All patients underwent radical excision of epidural granulation tissue/abscess and necrotic bone, whilst a proper tricortical iliac crest autograft and anterior titanium plate were placed to reconstruct the anteromedian spinal column, followed by chemotherapy for 18 months and immobilization in a brace for six months. The mean Cobb angle was 37.5° (ranged from 25° to 60°) before surgery.　Results　 All patients were followed up for two to eight years (three years on average), and got complete bone fusion within five to eight months postoperatively. There were no pull out and breakage of screws or plates.Spinal cord functional recovery improved on average 3.6 degree according Frankel standard, without recurrence of the disease or loss of Cobb angle till the last follow up. There was a statistically significant improvement in the Cobb angles from 22.6° to 37.5° (P lt;0.01) in average. However, two patients appeared transient hoarse voice after surgery, and the symptoms were alleviated one month after the operation.　Conclusion　 Lower anterior cervical approach combined with presternum-splitting approach for CTJST may provide adequate exposure to the lesion, keep the bone graft with internal fixation and spinal stability, and correct the kyphosis.

Citation： JIANG Cheng,YE Junwu,WEI Peng. Lower Anterior Cervical Approach Combined with Presternum-splitting Approach for Cervicothoracic Junction Spinal Tuberculosis. West China Medical Journal, 2010, 25(12): 2181-2184. doi: Copy