关键词: 结核, 脊柱/外科学, 胸椎, 腰椎, 骨钉, 内固定器, 脊柱融合术

Abstract: Objective To evaluate the efficacy of single-stage posterior pedicle screw instrumentation tho-rough Wiltse approach followed by anterior debridement and internal fixation for the surgical management of thoracic-lumbar tuberculosis. Methods One hundred and twenty-eight cases with thoracic-lumbar tuberculous spondylitis admitted in Shandong Provincial Chest Hospital were collected for the observational study from March 2011 to February 2013. There were 73 males and 55 females, and the lesion located at thoracic spine T_5-11 level in 35 cases, T₁₂—L₂ in 45 cases and L_3-5 in 48 cases. They were undergone posterior pedicle screw instrumentation thorough Wiltse approach combined with anterior radical debridement, decompression and internal fixation. All patients were treated with standard anti-tuberculosis chemotherapy through oral administration for a minimal length of 4 weeks before surgery and lasted 12 to 18 months after surgery(3HRZE/9—15HRE). All patients were followed up for 12 to 36 months, average （24±9） months. The laboratory examination including blood routine, ESR and CRP, body temperature and imaging evaluation were undergone at the 1st, 3rd, 7th day, 2 and 4 weeks postoperatively. Imaging examination was carried out at 2^nd and 4^th weeks and per 3 months postoperatively. The changes of clinical symptom, status of internal fixation, degree of kyphosis and grade of neurologic function were assessed.  Results No case was died and suffered from spinal cord, nerve, great vessel or organ injury during surgery. The complications were happened in 11 patients (18.6%). The average operating time and blood loss were (270±110) minutes and (360±210) ml including (70±25) minutes and (100±65) ml in posterior procedure, respectively. The body temperature and pain were the most serious in 1 to 3 days after operation. While the numerical value of WBC, ESR and CRP were highest. The Cobb’s angle was corrected 18.6° after surgery immediately, however, 1.9° loss was observed at the final follow-up before deinstrumentation and 1.1° loss after 3 months deinstrumentation. The ASIA Impairment Scale scores demonstrated significant improvement (95.3%, 102/107). All patients showed evidence of successful bone fusion by radiological evaluation and 115 patients (89.8%, 115/128) were at grade Ⅰor Ⅱ. They were achieved 97.7% (125/128) cure rate.  Conclusion The results demonstrates that cases with thoracic-lumbar tuberculosis，which treatment with posterior pedicle screw instrumentation thorough Wiltse approach combined with anterior debridement, decompression and interbody fusion, can achieve good clinical efficacy and get rapid postoperative recovery. It is a safe and effective method in the surgical management of thoracic-lumbar tuberculosis.

Key words: Tuberculosis, spinal/surgery, Thoracic vertebrae, Lumbar vertebrae, Bone nails, Internal fixators, Spinal fusion