关键词: 结核,脊柱, 清创术, 外科手术,微创性, 骨移植, 脊柱融合术, 结果评价(卫生保健)

Abstract:

Objective To explore the clinical efficacy of anterior debridement, bone graft fusion and posterior long-segment fixation with short pedicle screw method in treatment of patients with multiple lumbar spinal tuberculosis. Methods The clinic data of 17 multiple lumbar spinal tuberculosis patients who hospitalized and received surgery with the above mentioned operative method in Shaanxi Provincial Institute for Tuberculosis Control and Prevention from April 2013 to April 2015 were collected and analyzed. The clinical treatment outcomes of using the operative method was evaluated according to visual analog scale (VAS) and Oswestry dysfunction index (ODI), Cobb angle, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Frankel classification of neurological function, the status of bone fusion. SPSS 21.0 software was used for statistical analysis, matched t test was used to test the measurement data and P<0.05 was regarded as significant difference. Results The surgeries for all cases were successfully completed. All 17 patients were followed up 24-33 months after surgery and the average follow-up duration was (27.8±5.4) months. They were all cured. Of which, 2 patients developed paravertebral psoas abscess at 6 months after discharged from the hospital and was cured by excision of psoas abscess and adjustment of anti-tuberculosis treatment; the remaining 15 patients were normal during follow-up period. Before surgery, the VAS scores (7.9±1.4), ODI scores (72.5±7.9), Cobb angle (22.5±7.6)°, ESR (47.3±11.3) mm/1 h and CRP (32.6±9.4) mg/L in 17 patients were significantly higher than those at the last follow up ((2.1±0.9) scores, (30.3±6.6) scores, (10.8±4.4)°, (6.1±3.2) mm/1 h and (2.8±2.4) mg/L) and the differences had statistical significance (t=16.61, 4.18, 21.24, 2.44, 20.11; Ps<0.001). Among the 7 patients who had neurological symptoms before surgery, their Frankel Classification all reached E level at the last follow up after surgery. At 6 months follow-up after surgery, the fusion rate in the bone graft areas reached 94.1% (16/17) with grade Ⅰ in 14 cases, grade Ⅱ in 2 cases and grade Ⅲ in 1 case; at the last follow-up, the fusion rate reached grade Ⅰ with complete interbody fusion without recurrence or pseudoarthrosis in all patients. Conclusion The clinical treatment outcomes is good by using anterior debridement, bone graft fusion and posterior long-segment fixation with short pedicle screw in patients with multiple lumbar spinal tuberculosis.

Key words: Tuberculosis,spinal, Debridement, Surgical procedures,minimally invasive, Bone transplantation, Outcome assessment (health care)