关键词: 结核, 脊柱, 外科手术, 选择性, 清创术, 骨移植, 脊柱融合术, 手术后并发症, 治疗结果

Abstract:

Objective To explore the clinical effect of anterior approach surgery for lumbar tuberculosis. Methods Clinical data of 310 patients with lumbar tuberculosis who underwent anterior approach debridement+bone graft fusion+internal fixation in Chengdu Public Health Clinical Medical Center from 2006 to 2016 were collected. The curative effect of anterior approach surgery in treating lumbar tuberculosis was comprehensively evalu-ated as per intraoperative blood loss, changes in lumbar kyphosis angle (Cobb angle), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before and 3months after surgery, change in spinal nerve function (Frankel grading standard) before and after surgery, postoperative bone graft fusion (Bridwell grading standard), as well as complications and follow-up visits. Statistical analysis was performed using SPSS 20.0 software, and single-sample t-test was adopted for comparison of quantitative data, with P<0.05 suggesting difference of statistical significance. Results The operation time was 110-220min, averaging (154.46±32.11)min; the intraoperative blood loss was 220-600ml, averaging (380.64±108.35)ml. Finally, 279 patients received follow-up visits for 9 to 36months, (18.00±8.11)months in average, who all were clinically cured by the last follow-up visit. Thirty-one patients lost follow-up. Cobb angle ((15.17±6.36)°), ESR ((25.54±13.25)mm/1h), and CRP ((14.36±10.19)mg/L) 3months after surgery were all significantly lowered compared with those before surgery ( (25.26±7.34) °, (48.39±10.63)mm/1h, (31.24±13.86)mg/L, respectively) (t=16.62, 18.72, 15.08, P values <0.001). By the end of follow-up visit, out of 46 patients with preoperative neurological impairment, 34 patients (73.91%) recovered to normal (E grade) within 3 to 12months after surgery, 8 patients (17.39%) to D grade 12months after surgery, 2 patients (4.35%) to C grade 6months after surgery, and 2 patients (4.35%) never recovered. The bone graft fusion was in accordance with Bridwell class 1 standard, and the bone graft fusion rate was 100.00% (310/310), with the fusion time lasting from 4-17months, (8.10±5.31)months in average. Cerebrospinal fluid leakage occurred in 1 case 3days after operation, which was cured 10days later after receiving conservative treatment; postoperative atelectasis occurred in 5 cases, and satisfactory pulmonary resuscitation was achieved after receiving conservative treatment; 2 cases experienced loosening of internal fixation 9 and 20months after operation respectively, and after removal of the internal fixator, they were in good condition at the following follow-up visits; 3 cases formed sinus tract after operation, of whom 1 case underwent debridement again, and 2 cases recovered after adjusting antituberculosis therapy scheme and dressing change by the Internal Medicine Department of Tuberculosis of our hospital as per the results of drug sensitivity test; 2 cases had cold abscess and received paraspinal cold abscess absorption 3 to 7months after adjusting antituberculosis therapy scheme by the Internal Medicine Department of Tuberculosis of our hospital as per the results of drug sensitivity test. Conclusion On the basis of regulating effective treatment of antituberculosis drugs, anterior approach debridement+bone graft fusion+internal fixation for lumbar tuberculosis can effectively improve clinical symptoms and reduce postoperative complications, achieving satisfactory outcome in patients with lumbar tuberculosis.

Key words: Tuberculosis, spine, Surgical procedures, elective, Debridement, Bone transplantation, Spinal fusion, Postoperative complications, Treatment outcome