Comparison of therapeutic effects between calcium sulfate incorporated with rifamycin sodium and autologous bone grafting in the treatment of thoraco-lumbar tuberculosis

doi:10.19982/j.issn.1000-6621.20230094

Abstract

Abstract:

Objective: To evaluate the efficacy and safety of calcium sulfate incorporated with rifamycin sodium in the treatment of thoraco-lumbar spinal tuberculosis through posterior approach lesion clearance and internal fixation surgery. Methods: A retrospective study was conducted in patients with thoraco-lumbar tuberculosis admitted to the Orthopedics, Cadre Ward of Gansu Provincial Hospital from June 2019 to August 2022. According to whether or not to implant rifamycin sodium calcium sulfate, the patients were divided into drug-loading group (simple posterior approach lesion removal combined with rifamycin sodium sulfate implantation) and bone graft group (simple posterior approach lesion removal combined with autologous bone implantation). Of the 54 cases initially included (26 cases in the drug-loading group and 28 cases in the bone graft group), 4 were lost to follow-up, and 50 cases were finally included (25 cases in the drug-loading group and 25 cases in the bone graft group). Lesion segments: 28 cases in the thoracic spine, 7 cases in the thoraco-lumbar spine, and 15 cases in the lumbar spine. The operation time, blood loss, hospital stay, postoperative complications, levels of ESR and CRP preoperative, 3 months postoperative and in the last follow-up were recorded, as well as the Cobb angles preoperative, 3 day, 3 months and 6 months postoperative and in the last follow-up. Results: All the 50 patients were followed up for 7-16 months. There was no significant difference in operation time ((168.04±17.22) min vs. (163.96±16.07) min, t=0.750, P=0.282), blood loss (911.20±93.38) ml vs. (904.40±90.74) ml, t=0.068, P=0.795) and hospital stay ((15.96±1.21) d vs. (15.28±1.31) d, t=3.651, P=0.062) between the two groups. The levels of ESR and CRP 3 months postoperative, in the drug-loaded group were significantly lower than those in the bone graft group ((26.48±2.76) mm/1 h vs. (28.64±3.03) mm/1 h, t=2.639, P=0.011; (3.45±0.79) mg/L vs. (4.41±1.15) mg/L, t=3.454, P=0.001). The Cobb angles in the bone graft group 6 months postoperative and in the last follow-up were significantly lower than those in the bone graft group ((12.32±0.68)° vs. (12.84±1.02)°, t=2.115, P=0.034; (12.43±0.76)° vs. (12.94±0.81)°, t=2.278, P=0.027). Conclusion: Simple posterior approach lesion removal combined with rifamycin sodium sulfate implantation for the treatment of thoraco-lumbar tuberculosis could achieve the goal of complete removal of lesions and reconstruction of spinal stability.

Key words: Calcium sulfate, Rifamycins, Tuberculosis, spinal, Bone transplantation, Surgical procedures, operative

CLC Number:

R529.2
R81

Wu Yunbiao, Pu Xingyu, Qi Yang, Kou Xianshuai, Xie Wendong, Luo Wenyuan, Liu Shengfen. Comparison of therapeutic effects between calcium sulfate incorporated with rifamycin sodium and autologous bone grafting in the treatment of thoraco-lumbar tuberculosis[J]. Chinese Journal of Antituberculosis, 2023, 45(7): 673-680. doi: 10.19982/j.issn.1000-6621.20230094

Figures/Tables 7

References 32

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ASIA分级	载药组(25例)			植骨组(25例)
ASIA分级	术前	术后	末次随访	术前	术后	末次随访
A	0	0	0	0	0	0
B	1	0	0	1	0	0
C	6	3	0	4	3	0
D	12	11	5	12	10	6
E	6	11	20	8	12	19

组别	例数	术前	术后3个月	末次随访	F值	P值	术前vs.术后3个月		术前vs.末次随访
组别	例数	术前	术后3个月	末次随访	F值	P值	t值	P值	t值	P值
ESR(mm/1h)
载药组	25	38.72±8.28	26.48±2.76	7.40±1.91	82.261	<0.001	7.010	<0.001	18.420	<0.001
植骨组	25	38.40±8.11	28.64±3.03	7.24±1.79	71.027	<0.001	5.640	<0.001	18.780	<0.001
t值		0.138	2.639	0.306
P值		0.891	0.011	0.821
CRP(mg/L)
载药组	25	19.40±4.78	3.45±0.79	2.09±0.66	291.073	<0.001	16.480	<0.001	17.950	<0.001
植骨组	25	18.89±4.34	4.41±1.15	2.20±0.75	297.715	<0.001	16.130	<0.001	18.950	<0.001
t值		0.396	3.454	0.504
P值		0.694	0.001	0.616

组别	例数	术前	术后3d	术后6个月	末次随访
载药组	25	24.31±2.51	11.78±0.78	12.84±1.02	12.94±0.81
植骨组	25	25.03±1.87	11.42±1.09	12.32±0.68	12.43±0.76
t值		1.167	1.330	2.115	2.278
P值		0.249	0.190	0.034	0.027

组别	例数	术前	术后3个月	术后6个月	末次随访
VAS评分
载药组	25	8.36±0.76	3.48±0.51	1.64±0.09	1.36±0.57
植骨组	25	8.12±1.01	3.76±0.52	1.88±0.44	1.56±0.58
t值		0.949	1.917	1.823	1.228
P值		0.475	0.068	0.080	0.179
JOA评分
载药组	25	12.72±2.44	19.56±1.87	21.28±1.46	24.28±1.24
植骨组	25	13.28±2.23	19.16±1.81	21.32±1.60	24.64±1.12
t值		0.847	0.766	0.660	1.079
P值		0.401	0.447	0.927	0.280
ODI指数
载药组	25	60.48±8.63	32.24±3.78	18.56±2.79	14.04±1.46
植骨组	25	59.52±8.53	31.68±4.23	19.60±2.38	13.44±1.08
t值		0.396	0.494	1.346	1.652
P值		0.992	0.498	0.199	0.182