关键词: 结核,脊柱, 清创术, 骨移植, 脊柱融合术, 内固定器, 治疗结果

Abstract:

From January 2006 to January 2015, 45 patients with thoracolumbar tuberculosis treated with one stage anterior debridement, titanium mesh-bone graft fusion and posterior internal fixation in the First People’s Hospital of Yidu in Hubei province were included in this analysis. Among them, 20 cases were males, and 25 were females. They aged from 23 to 72 years old, with an average age of (46.02±10.13) years. There were 20 cases with thoracic tuberculosis, 10 cases with thoracolumbar spinal tuberculosis, 8 case with lumbar vertebral tuberculosis, and 7 cases with lumbosacral tuberculosis. The operation time, intraoperative blood loss, visual analogue scale (VAS) score, Frankel grade, angle of kyphosis, and erythrocyte sedimentation rate (ESR) before and after surgery were evaluated, as well as complications and bone graft fusion status. The average operation time of the 45 patients was (230.27±15.86)min, and the intraoperative hemorrhage was (489.89±35.87)ml. The preoperative VAS score was (7.50±1.13), and it decreased to (0.89±1.67) 3months after operation. The difference was statistically significant (t=22.23, P<0.001). As to postoperative neurological improvement, of the 7 cases with Frankel grade B before surgery, 4 cases recovered to grade E and 3 cases recovered to grade D; of the 8 cases with grade C and 15 cases with grade D before operation, all recovered to grade E. Preoperative kyphosis angle was (33.93±7.01)°, while the kyphosis angle was reduced to (15.07±3.45)° 3months after the operation; the difference was statistically significant (t=16.20, P<0.001). ESR decreased from (69.75±14.62)mm/1h before surgery to (13.16±5.27)mm/1h 3months after surgery; the difference was statistically significant (t=23.81, P<0.001). The 45 patients were followed up for 24-70months. No serious complications occurred after operation, bone graft was fused in all patients, and no internal fixation loosening and fracture appeared. Hence, we concluded that the one stage anterior debridement, titanium mesh-bone graft combined with posterior internal fixation for patients thoracolumbar spinal tuberculosis can effectively correct spinal deformity, reconstruct spinal stability, and improve the cure rate of spinal tuberculosis.

Key words: Tuberculosis,spinal, Debridement, Bone transplantation, Spinal fusion, Internal fixa-tors, Treatment outcome