关键词: 结核, 脊柱, 脊柱侧凸, 外科手术, 选择性, 治疗结果, 评价研究

Abstract:

Objective To investigate the short-term clinical effectiveness of one-stage anterior debridement, posterior bone grafting and fusion and posterior pedicle internal fixation in the treatment of tuberculous scoliosis.Methods 36 patients with spinal tuberculosis admitted in Xi’an Chest Hospital from January 2010 to December 2016 were retrospectively analyzed. One stage anterior debridement, posterior bone graft fusion and transpedicular internal fixation had been performed on those patients after sufficient anti-tuberculosis treatment, postoperative diagnosis were confirmed as spinal tuberculosis. The operation time, blood loss, incision healing, postoperative complications, status on last follow-up, and changes in the tuberculosis caused symptoms were recorded. The changes of visual analogue score (VAS) before operation, 2 weeks after operation and at the last flow-up were observed. The changes of Cobb angle were compared for before operation, 2 weeks after operation and at the last flow-up. Immediately after operation and at the last follow-up, X-ray films were taken to determine the changes of scoliosis and the complications associated with internal fixation.Results The operation time ranged from 150-300 minutes, with an average of (206.33±35.08) minutes. The intra-operative blood loss was 200-1000 ml, with an average of (525.00±193.31)ml. The mean follow-up duration ranged from 18-36 months, with an average of (24.16±5.82) months. All 36 cases were cured without recurrence, without pus and sinus formation and complications associated with screw insertion during follow-up period. All patients with tuberculosis related symptoms and pains disappeared in spine lesions area; visual analogue scale (VAS) decreased significantly: the average score was (6.13±2.06) before operation, (3.30±1.66) at 2 weeks after operation (t=16.337,P=0.00,with statistically significant difference) and (1.46±0.73) at the last follow-up (t=7.487,P=0.00,with statistically significant difference comparing with 2 weeks after operation); Kyphotic angles of all patients recovered well: the average Cobb angle of scoliosis was (23.03±7.44) °before operation, (7.63±2.83)° at 2 weeks after operation (t=11.924,P=0.00,with statistically significant difference) and (7.73±2.75) °(t=-1.795,P=0.08, without statistically significant difference comparing with 2 weeks after operation); X-ray films at last follow-up showed no obvious loss with scoliosis (convex), no loosening for internal fixation device and side nail, no shift or fracture fixation failure.Conclusion Tuberculous scoliosis of spine treated by single-stage anterior debridement, posterior fusion and internal fixation had a definite curative effectiveness.

Key words: Tuberculosis, spinal, Scoliosis, Surgical procedures, selective, Treatment outcome, Evaluation studies