关键词: 结核, 脊柱, 外科手术, 选择性, 骨移植, 骨钉, 治疗结果

Abstract:

Objective To investigate the clinical efficacy of one-stage anterior debridement combined with rib graft fusion and anterior internal fixation with nail for diseased vertebrae.Methods Thirty patients with spinal tuberculosis who were admitted in Xi’an Chest Hospital and performed one-stage anterior debridement combined with rib grafting and anterior internal fixation during Jan. 2013 to Dec. 2015. There were 11 males and 19 females with average age (44.2±12.4) years old ranged from 23 to 70.The lesion segments were involved from T5 to L1 (no more than 2 segments in all cases). Operative time, intraoperative bleeding volume, incision healing, postoperative complication, and toxic symptoms of tuberculosis were recorded in all cases. The visual analogue scales (VAS) were observed before operation and two weeks and two years after operation in all cases. The neurological function Frankel grade according to the American Spinal injury Association (ASIA) were observed after operation. There were grade A in 3 cases, grade B in 2 cases, grade C in 5 cases, grade D in 12 cases and grade E in 8 cases before operation. The Cobb angles were compared before operation, two weeks and two years after operation in all cases.Results The average operative time was (178.0±33.6) min ranged from 120 to 240 min and average intraoperative bleeding volume was (507.5±148.9) ml ranged from 300 to 800 ml. No relapse cases, no incision healing poor, no complication with sinus and screw loosening occurred during average follow-up (25.9±6.6) months ranged from 24 to 36 months. The toxic symptoms of tuberculosis and spinal pain disappeared in all patients. The average VAS in the group after operation (1.4±0.5) was significantly lower than that before operation (6.5±1.5) at the last follow-up (2 years after operation) with significant difference statistically (t=15.759,P=0.000). The Frankel grades were no cases with grade A, grade B and grade C in each one case, grade D in 2 cases and grade E in 26 cases at the last follow-up (2 years after operation). The Cobb angle was average (19.1±7.4)° before operation and (13.6±3.9)° at the last follow-up. The improvement of Cobb angle before and after operation was significant difference statistically (t=5.003,P=0.000). The lesions of spinal vertebrae were basically healed and bone nonunion and pseudoarthrosis were not found in the patients. There were no screws of internal fixation loosened and broken and no bone graft absorbed and disappeared.Conclusion It is feasible for the treatment of spinal tuberculosis using one stage anterior debridement with rib graft fusion and anterior internal fixation with nails for diseased vertebrae. The operation is safe and reliable, and the efficacy of short-term follow-up is satisfactory.

Key words: Tuberculosis, spinal, Surgical procedures, selective, Bone transplantation, Bone nails, Treatment outcome