关键词: 结核, 脊柱/外科学, 胸椎, 腰椎, 回顾性研究

Abstract: Objective  To investigate the surgical treatment effect of multi-segmental thoracolumbar tuberculosis in patients who underwent debridement, bone grafting and internal fixation combined with anti-tuberculosis chemotherapy. Methods  Fifty adult patients with multi-segmental thoracolumbar tuberculosis,admitted in the 309th hospital of the PLA from October 2009 to September 2011, undergone different surgical procedures were reviewed retrospectively. All patients were divided 4 groups as follows according to site and extent of the lesion, Frankel level, the kyphosis Cobb angle, surgical treatment and clinical outcome. Group A included 10 cases who underwent anterior radical debridement, bone grafting and internal fixation. Group B included 6 cases who underwent posterior instrumentation and interlaminar bone graft plus anterior radical debridement and strut graft either by one-stage or two-stage. Group C included 22 cases who underwent front side radical debridment，strut graft and posterior instrumentation in thoracic or thoracolumbar spine. Group D included 12 cases who underwent single-stage posterior debridement and instrumentation. Eighteen patients suffered neurological deficit including 12 cases for Frankel D, 4 cases for Frankel C, 2 cases for Frankel B，32 cases for Frankel E. The kyphosis Cobb angle ranged from 10°to 20°in 16 cases，over 20°in 18 cases. Frankel level and the Cobb angle were compared before and after operation in follow-up patients. Results  The average operation time and blood loss were （3.6±0.6）h and （455±54）ml in group A，（4.7±0.8）h and （670±58）ml in group B，（4.8±0.9）h and （630±62）ml in group C, （4.1±0.7）h and （420±46）ml in group D. ESR restored to normal value about 8-12 weeks after operation,and the patient’s symptoms were significantly improved about 1-3 weeks after operation. At the last time of follow-up，14 cases had improved 1 grade, and 4 cases improved with 2 grades in Frankel level. Kyphosis Cobb angle was corrected by 45.6%±12.3%, with loss of correction about 23.7%±20.4% at last time of follow-up in 50 patients. Conclusion  The radical debridement and bone grafting can improve satisfactorily the efficacy in patients with multi-segmental thoracolumbar tuberculosis based on the scope of vertebrae damage,the site and size of abscess, and different surgical procedure and internal fixation.

Key words: Tuberculosis, spinal/surgery, Thoracic vertebrae, Lumbar vertebrae, Retrospective studies