关键词: 性能强化物质, 椎体成形术, 结核, 脊柱, 复发, 再手术, 方案评价

Abstract:

Objective To analyze the clinical features of patients with thoracolumbar tuberculosis who have undergone vertebral augmentation and explore its surgical treatment and efficacy. Methods The clinical data of 11 cases of thoracolumbar tuberculosis who had undergone vertebral augmentation from March 2015 to April 2017 were retrospectively analyzed. According to whether the bone cement mass was removed during the operation, the patients were divided into two groups: posterior thoracolumbar decompression, bone cement removal, and bone graft fusion (group A, n=5); Posterior thoracolumbar decompression and bone graft fusion (group B, n=6). Anti-tuberculosis treatment lasted for 18 to 24 months according to drug sensitivity of MTB. Results 10 out of 11 patients, had increased preoperative ESR and CRP, and 10 were positive for tuberculosis T cell spot test (T-SPOT.TB), and 1 patient had normal ESR, CRP and negative T-SPOT.TB. The VAS of back pain and limb pain of the follow-up patients improved to different extents. The ESR and CRP decreased to normal range within 3 months after operation. The preoperative ESR and CRP results in group A and group B were (44.40±9.45)mm/1h, (19.80±2.59)mg/L, (44.17±14.22)mm/1h and (19.17±8.70)mg/L, and those were (12.40±3.21)mm/1h, (3.00±1.58)mg/L, (12.00±2.45)mm/1h and (3.33±1.21)mg/L 3 months after surgery, and the results in the last follow-up were (12.00±2.65)mm/1h, (2.80±0.84)mg/L, (12.17±3.31)mm/1h and (3.00±0.89)mg/L respectively. There were significant differences between the two groups at 3 months after treatment and before treatment (t=7.170, 12.382, 5.461, 4.417, respectively, P values all were 0.000, respectively). There was no significant difference between 3 months after treatment and the last follow-up (t=-0.215, -0.250, 0.101, -0.538, respectively, and P values were 0.835, 0.809, 0.922, 0.602, respectively). X-ray photography and CT scan showed that the diseased vertebrae healed well. In the last follow-up, 8 cases of ASIA were completely restored and 3 cases were partially recovered. The modified Barthel indexes of the two groups before and after treatment (before treatment: 39.21±11.73 and 40.32±10.16; in the last follow-up: 91.31±7.74 and 89.45±8.52, respectively) were statistically significant (t=8.290 and 9.076, Ps=0.000, respectively).There was no significant difference between the groups after treatment (t=0.375, P>0.05). Conclusion Both groups achieve good therapeutic effects, and individualized surgical treatment should be adopted for the patient with thoracolumbar tuberculosis who has undergone vertebral augmentation.

Key words: Performance-enhancing substances, Vertebro plasty, Tuberculosis, spinal, Recurrence, Reoperation, Programme evaluation