Abstract:

Objective To explore the effect of cortical bone trajectory (CBT) screw fixation on enhanced recovery after surgery(ERAS)in elderly patients with lumbar tuberculosis. Methods Seventy-eight elderly patients with lumbar tuberculosis who underwent surgical treatment from January 2019 to January 2020 in Hangzhou Chest Hospital were enrolled. The patients were divided into CBT group and traditional group according to internal fixation methods, and then managed with ERAS. Among them, there were 38 cases in the CBT group admitted from July 2019 to January 2020, including 21 males and 17 females, average age (73.95±5.30) years; average T value of bone mineral density was -2.34±0.46; 30 cases got single-segment vertebral destruction, 8 cases got two-segment vertebral destruction; 12 cases with diabetes mellitus, 16 cases with hypertension, and 27 cases with pulmonary tuberculosis. There were 40 cases in the traditional group admitted from January 2019 to June 2020, including 23 males and 17 females, average age (73.75±5.02) years; average T value of bone density was -2.22±0.40; 34 cases got single-segment vertebral body destruction, 6 cases got two-segment vertebral body destruction; 13 cases with diabetes mellitus, 15 cases with hypertension, 30 cases with pulmonary tuberculosis. The operation time, intraoperative blood loss, 24 h postoperative VAS score, postoperative bedding time, length of hospital stay and postoperative complications were compared between the two groups. Results The operation time ((231.34±8.57) min), intraoperative blood loss ((483.34±58.90) ml), 24 h postoperative VAS score (4.11±0.83), postoperative bedding time ((7.32±1.85) d), length of hospital stay ((21.82±4.57) d) in CBT group were significantly lower than the traditional group ((246.98±11.81) min), ((517.48±37.16) ml), (5.10±1.06), ((8.33±1.62) d), ((24.38±3.25) d), the differences between them were statistically significant (t values were -6.664, -3.077, -4.601, -2.567, -2.863,P values were 0.000, 0.003, 0.000, 0.012, 0.005 respectively). In addition, the complication rate in the CBT group was 2.6% (1/38), while 7.5% (3/40) in the traditional group (χ²=0.949,P=0.330). Conclusion CBT screw fixation has a positive effect on ERAS in elderly patients with lumbar tuberculosis, which can significantly reduce intraoperative blood loss and operation time, promote recovery and shorten the length of hospital stay.

Key words: Tuberculosis, spinal, Aged, Internal fixator, Surgery, ERAS, Comparative study