关键词: 结核, 脊柱/外科学, 胸椎, 内固定器, 脊柱融合术

Abstract: Objective To explore the indications, efficacy and treatment outcomes of one-stage posterior focus debridement, bone graft and internal fixation operation for the patients with upper thoracic vertebral tuberculosis (TB). Methods The information of the patients with upper thoracic vertebral TB and in different degrees of paraplegia, who received one-stage posterior focus debridement, bone graft and internal fixation operation in Beijing Chest Hospital between March 2006 and October 2012, were collected. There were 17 patients in total, including 12 males and 5 females with ages ranged from 4 to 67 years (median: 49 years). Combination chemotherapy with 4-5 anti-TB drugs (isoniazid, rifampicin or rifapentine, ethambutol, pyrazinamide, or/and levofloxacin) were administered to all patients before and after the operations. The duration of the pre-operative anti-TB treatment were 2-96 weeks (mean: 10.3 weeks); the duration of the post-operative anti-TB treatment were 12-18 months.  Results The operation time ranged from 165 minutes to 300 minutes, with an average of (224.11±41.35) minutes. The intra-operative blood loss was 300-1500 ml, with an average of (752.94±435.70) ml. The major complications after operations were incision effusion (4 cases) and bedsore (1 case). The average of Cobb’s angle was (23.96±6.67)°and (19.21±5.97)°respectively before and after operations. The mean follow-up duration was 14 months (range: 12-30 months). All the patients were cured after treatment. The rate of inter-body fusion was 100.00% and no relapse by the end of follow-ups. Ten patients with paraplegia recovered to degree D or E according to the neurological classification of American Spinal Injury Association (ASIA).  Conclusion One-stage posterior focus debridement, bone graft and internal fixation is an effective and feasible treatment for the patients with upper thoracic vertebral TB.

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