关键词: 结核, 脊柱/外科学, 胸椎, 截瘫, 治疗结果

Abstract: Objective To investigate the efficacy of surgical treatment in patients with focus-active thoracic vertebral tuberculosis combined with paraplegia and the impact of paraplegia time on neurological function recovery.  Methods From Jan 2011 to Jan 2014, 67 patients with focus-active thoracic vertebral tuberculosis combined with paraplegia had taken in surgical treatment in the department of orthopedics of Beijing Chest Hospital, Capital Medical University. All the patients were followed up by clinical and radiography for an average period of 14 (12－28) months. And all of them had taken in surgical treatment after received preoperative chemotherapy for more than 2 weeks, and the toxic symptom alleviated. The clinical outcomes of the surgical treatment was analyzed by visual analogue scale (VAS), Cobb angle, paraplegia time and ASIA scale. The Cobb angle and the VAS score were analyzed by the Paired Samples t test. The Wilcoxon test was applied to analyze the differences of ASIA scale between before operation and the final follow-up. The ordinal logistic test was used to analyze the correlation of the paraplegia time and the ASIA scale at the final follow-up.  Results The Cobb angle (23.18±12.07)° had satisfactory improvement at 3 weeks after operation (14.92±9.12)° and at the final follow-up (16.45±9.18)°, t:3.58 and 2.99,P<0.05. The VAS (6.83±1.40) also improved significantly at 3 weeks after operation (3.42±0.99) and at the final follow-up (1.75±0.62), t:10.92 and 11.70, P<0.05.The ASIA scale showed significant difference between one day before operation and the final follow-up by the Wilcoxon test (A scale in 3 patients, B scale in 10 patients, C scale in 33 patients, D scale in 21 patients one day before the operation, and A scale and B scale in 0 patients, C scale in 3 patients, D scale in 6 patients, E scale in 58 patients at the final follow-up), Z=7.246，P<0.05. The average paraplegia time was (7.87±4.90) (1 to 24) weeks. The final ASIA scale showed uncorrelated with the para-plegia time by the ordinal logistic test (β=0.051, χ²=0.269, P=0.604). All the 67 cases had achieved rigid bony fusion, the average time was (3.81±1.43) (3 to 6) months. And there was no recurrence case.  Conclusion The debridement, decompression and internal fixation surgery can achieve well clinical efficacy and recovery of neural function in the patients with focus-active thoracic vertebral tuberculosis combined with paraplegia. The paraplegia time had no significant effect on the neurological recovery.

Key words: Tuberculosis, spinal/surgery, Thoracic vertebral, Paraplegia, Treatment outcome