| Objective:To evaluate the feasibility of rib bundles strutgrafting in the reconstruction of spinal stability after debridement of middlethoracic tuberculosis. Methods:Select30inspectors who do chest vascularCTA In radiology department.Process the three-dimensional reconstructionimages by Volume Viewer processing software after find the ribs will measurein reconstruction image. In the recon-struction image determine the rib Angleand its anterior axillary line.The rib was made straight by use of such software andabsolute length of the ribs was calculated. Cross-sectional area was measuredon three point.The height of various combination of a vertebrae+2discs andtwo vertebraes+3discs was measured on CT sagittal images;Thecross-sectional area of vertebral superior border and inferior border wasmeasured by CT measuring software on Cross-sectional images.From2007to2010,18patients with middle thoracic tuberculosis, including11males and7females, were treated by debridement and strut graft with rib bound strut graf-ting with instrumentations. The average age was48years old (range from25to62). The locations of lesions include5cases of T5-T6,4cases of T6-T7,4cases of T7-T8,5cases of T8-T9. Kyphosis deformity presented in18patientswith an average Cobb angle of23°(range form10°to40°);neurologicalsymptomms were developed in14patients, encompassing1case of grade B,2 cases of grade C,11cases of grade D(rated by Frankel grading); Completepreope-rative examination and rule out operation contraindication disease.Antitubercular treatment2~4weeks.After tuberculosis poisoning symptomsimprove, operation were done by the rib resection and rib bound strut graftingand instrumentation.Follow-up the clinical curative effect of this group ofpatients.Results: The length of4-8ribs is18.8-19.5cm from rib Angle to theanterior axillary line, each rib length no obvious difference (P>0.05). Thedefault of T4-T9and2discs adjacent need support height respectively is2.5±0.2cm,2.7±0.1cm,2.7±0.2cm,2.8±0.2cm,2.9±0.1cm,3.0±0.1cm.Corresponding ribs3section can provide support height respectively is6.2±0.1cm,6.2±0.1cm,6.4±0.3cm,6.5±0.2cm,6.4±0.2cm,6.5±0.2cm. Theheight of4-8rib provide support significantly greater than the default value (P<0.05). It is4.2±0.2cm that T4-T5and3discs adjacent default need supportheight;it is4.3±0.2cm that T4-T5and3discs adjacent default need supportheight;it is4.5±0.2cm that T4-T5and3discs adjacent default need supportheight;it is4.6±0.2cm that T4-T5and3discs adjacent default need supportheight;it is5.0±0.2cm that T4-T5and3discs adjacent default need supportheight.Corresponding ribs3section can provide support height respectively is6.2±0.1cm,6.2±0.1cm,6.4±0.3cm,6.5±0.2cm,6.4±0.2cm. The height of4-8rib provide support significantly greater than the default value (P <0.05).Two parts cross-sectional area of ribs is about1.4±0.2cm~2, three cutcross-sectional area of ribs is about2.1±0.3cm~2. T4-T6vertebral cross-sectional area is3.9±0.6cm~2,4.3±0.6cm~2,4.6±0.6cm~2, two ribscross-sectional area accounts for the percentage of vertebral body cross-sectionalarea respectively is35%,32%,30%; T7-T9vertebral cross-sectional area is4.9±0.5cm~2,5.3±0.6cm~2,5.8±0.7cm~2, three ribs cross-sectional area accountsfor the percentage of vertebral body cross-sectional area respectively is42%,39%,36%.18cases of patients with bone defect need to support height is2.6-5.0cm,the length of rib resected is15.016.8cm,3section bound can providesupport average height is5.4cm (5.0-5.6cm). The final follow-up6patientsfound0.1cm sinking,2cases of sinking0.2cm,0.3cm in1sinking. Supportheight lost no obvious difference (t=0.27, P>0.05). Postoperative X-ray filmsCobb ’saverage11°(range0-17), correct2-22°, average12°, average correctrate is52%, compared with the preoperative was statistically significant (t=7.27, P <0.05). Found no significant correction follow-up degree lost (t=1.68,P>0.05).18cases of patients with osteoarthritis postoperative meet all thefusion.conclusion：1. The fourth to eighth rib can provide the graftrequirements for spinal tuberculosis that after two thoracic vertebra resectedin middle thoracic spine2. The cross-sectional area of rib bundles，more than30%of the cross-sectional area of vertebral body，can increase the contact areaof bone, prevent bone to sink, increasing support, prevent early fall off and shift... |
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