Subscapularis Transthoracic Versus Posterolateral Approaches in the Surgical Management of Upper Thoracic Tuberculosis A Prospective, Randomized Controlled Study
Subscapularis Transthoracic Versus Posterolateral Approaches in the Surgical Management of Upper Thoracic Tuberculosis A Prospective, Randomized Controlled Study
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DOI：
10.1097/md.0000000000001900
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发表时间：
2015-11-01
期刊：
影响因子：
1.6
通讯作者：
Guo, Zhi-Min
中科院分区：
文献类型：
--
作者：
Lin, Bin;Shi, Ji-Sheng;Guo, Zhi-Min
本研究的目的是评估肩胛下经胸手术入路和后外侧手术入路清创、植骨融合和内固定治疗上胸椎结核的临床、放射学和功能结果。目前对于治疗上胸椎结核的最佳手术入路存在争议。传统上，首选肩胛下肌经胸入路。然而，后外侧入路在过去几年中越来越受欢迎。 对 43 名平均年龄为 39 岁（范围：20-52 岁）的前瞻性连续队列进行了至少 12 个月（范围：12-60 个月）的随访。患者被随机分为 2 组。 A组（n=21）采用肩胛下经胸入路治疗，B组（n=22）采用后外侧入路治疗。所有病例均进行临床、放射学和功能结果评估。采用术中失血量、手术时间、术中术后并发症、住院时间、治愈率、融合时间和Frankel量表进行临床和功能评价，后凸角用于放射学评价。所有病例的植骨均在10个月时融合。术前各组间性别、年龄、节段性结核、红细胞沉降率（ESR）、Frankel量表、Cobb角等方面比较，差异均无统计学意义（P>0.05）。 B组平均手术时间短于A组，术中出血量、术中术后并发症、住院时间、移植骨融合时间、治愈率等方面组间差异均无统计学意义（P>0.05）。 B组Cobb角矫正率(68.5%)明显优于A组(30.9%)。两组术后神经功能评分均有明显改善，但组间无显着性差异。经胸肩胛下入路和后外侧入路清创、植骨融合、内固定均足以满足上胸椎结核的手术治疗。然而，后外侧入路在手术创伤、手术时间和脊柱后凸矫正方面优于肩胛下肌入路。
The objective of the present study was to evaluate the clinical, radiological, and functional outcomes of a subscapularis transthoracic surgical approach and a posterolateral surgical approach with debridement, bone graft fusion, and internal fixation for the treatment of upper thoracic tuberculosis.There is currently debate over the best surgical approach for the treatment of upper thoracic tuberculosis. Traditionally, the subscapularis transthoracic approach has been preferred; however, the posterolateral approach has gained popularity in the past few years.A prospective, consecutive cohort of 43 upper thoracic tuberculosis patients with a mean age of 39 years (range: 20-52 years) was followed up for a minimum of 12 months (range: 12-60 months). Patients were randomly divided into 2 groups. Group A (n=21) was treated by the subscapularis transthoracic approach and group B (n=22) was treated by the posterolateral approach. All cases were evaluated for clinical, radiological, and functional outcomes. Intraoperative blood loss, operative duration, intraoperative and postoperative complications, hospital stay, the cure rate, fusion time, and the Frankel scale were used for clinical and functional evaluation, whereas the kyphosis angle was used for radiological evaluation.Grafted bones were fused by 10 months in all cases. There was no statistically significant difference between groups before surgery in terms of gender, age, segmental tuberculosis, erythrocyte sedimentation rate (ESR), Frankel scale, or Cobb's angle (P>0.05). The average operative duration for Group B was lower than that of Group A. There were no significant differences in intraoperative blood loss, intraoperative and postoperative complications, hospital stay, grafted bone fusion time, or cure rate between groups (P>0.05). The Cobb's angle correction rate for group B (68.5%) was significantly better than that of group A (30.9%). The neurological score showed significant postoperative improvement in both groups, with no significant difference between the groups.The subscapularis transthoracic approach and the posterolateral approach with debridement, bone graft fusion, and internal fixation are both sufficient and satisfactory for the surgical treatment of upper thoracic tuberculosis. However, the posterolateral approach is superior to the subscapularis transthoracic approach in terms of surgical trauma, operative time, and kyphosis correction.