Abstract:

Objective To evaluate the curative effect of percutaneous pedicle screw internal fixation combined with small abdominal incision debridement for lumbar tuberculosis in old patients.Methods From March 2014 to March 2017, 56 old patients with lumbar tuberculosis in Zhejiang Integrated Traditional and Western Medicine Hospital met the inclusion criteria were divided into group A and group B. All patients were received the standard anti-tuberculosis chemotherapy. Patients in group A were underwent percutaneous pedicle screw internal fixation combined with small abdominal incision debridement and interbody fusion with bone grafting. Patients in group B were underwent pedicle screw internal fixation and anterior debridement and interbody fusion with bone grafting. The volume of surgical bleeding, operation time, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), segment kyphotic Cobb angle, accuracy of nailing and lumbar function were compared and analyzed between the two groups. SPSS 17.0 statistical software was used for data analysis, t test and χ ² test were used, and P<0.05 was the significant difference.Results Fifty-six patients were followed up for an average of 16.00±4.51 months ranged from 12 to 20 months. No mixed infection, relapse of tuberculosis, pedicle screw loosening and retreating were found. The bleeding volume in the group A was (154.37±11.28) ml and the group B was (297.28±30.73) ml. The operation time was (193.56±15.72) min in the group A and (205.07±19.80) min in the group B. The mean operation time and bleeding volume in group A were less than those in group B with significant difference (t=6.412,t=3.937,P=0.000). The accuracy of pedicle screw placement was 85.80% (151/176) in group A and 84.18% (149/177) in group A. There was no significant difference in the accuracy of pedicle screw placement between the two groups (χ ²=0.359, P=0.549). Postoperative complications occurred 16 cases (57.14%) in group A and 17 cases (60.71%) in group B without significant statistically difference between the two groups (χ ²=0.074,P=0.786). Japanese Orthopaedic Association Scores (JOA) score of lumbar function, preoperative follow-up was (6.37±0.51) scores in group A and (6.41±0.61) scores in group B, 1 month after operation was (16.82±2.75) scores in group A and (19.03±3.57) scores in group B. There was significant difference between the two groups (t=0.128, P=0.036), the last follow-up was (26.71±3.91) scores in group A and (27.23±5.23) scores in group B, there was no significant difference between the two groups (t=0.279, P=0.782).Conclusion The early curative effect of group A and group B was satisfactory,but the former had the advantages of less trauma, shorter operation time and less bleeding than the latter.

Key words: Tuberculosis, spinal, Aged, Surgical procedures, minimally invasive, Spinal fusion, Comparative effectiveness research