关键词: 结核, 脊柱/外科学, 胸椎, 截瘫, 脊柱融合术, 减压术, 外科, 内固定器, 治疗结果, 老年人

Abstract: Objective To investigate the effects of surgical treatment for elder thoracic spinal tuberculosis (TB) patients with paraplegia by using the same approach of the debridement and bone grafting fusion with internal fixation.  Methods From February 2012 to October 2013, a total of 26 elder patients (aged over 60 years old) with thoracic spinal TB and paraplegia were treated at Shenyang Chest Hospital by using the same approach of the debridement and fusion with internal fixation surgical treatment. Among them, 18 patients were male and 8 patients were female; the average age was (64.4±5.1) years old; the duration of TB treatment was 5-17 months with an average of (12.4±4.2) months. The Frankel grading method and the American Spinal Injury Association (ASIA) function scale were used for grading spinal injury severity of the patients and the results were: Grade B in 17 cases, Grade C in 7 cases, Grade D in 2 cases. The erythrocyte sedimentation rate (ESR) of the patients was (62.7±6.5) mm/1 h and the Cobb angle was (24.4±3.1)°. The patients were followed up after they received surgical operations and the following information was collected: symptoms improvement, the time of vertebral lamina bone graft fusion, the Frankel grading and the Cobb angle.  Results The postoperative follow-up duration for those 26 patients was 6-12 months with an average of （11.3±2.7） months. The intercostal pain disappeared in 7 patients who suffered it before operations. The time of vertebral lamina bone graft fusion was about 6-8 months. The Frankel grading of 26 patients with paraplegia after 1 year of operations was: Grade D in 1 patient and Grade E in the remaining 25 patients. After a week of the operation, the Cobb angle was corrected to (19.3±4.3)° from (24.4±3.1)°. During the follow-up period, no internal fixation loosening or broken were observed.  Conclusion The treatment outcomes of surgical treatment with the same approach of the debridement and bone grafting fusion with internal fixation among elder thoracic spinal TB patients with paraplegia are satisfied. It may be a good option for surgical treatment in those patients.

Key words: Tuberculosis, spinal/surgery, Thoracic vertebrae, Paraplegia, Spinal fusion, Decompression, surgical, Internal fixators, Treatment outcome, Aged