A comparative study on the nutritoinal status of patients with bone tuberculosis and pulmonary  tuberculosis

Objective To evaluate the efficacy and results of single-stage posterior circumferential decompression, interbody bony fusion and posterior instrumentation in the treatment of spinal tuberculosis complicated with paraplegia, in order to investigate the indications and feasibility of this procedure.  Methods Eighteen patients with thoracic or thoracolumbar spinal tuberculosis with paraplegia treated by single-stage posterior circumferential decompression, interbody bony fusion and posterior instrumentation at the authors’ clinic from Jun 2008 to Jun. 2012 were retrospectively analyzed. There were11 males and 7 females, the mean age at the initial treatment was （39.5±4.8）years (range: 23 to 72 years). The mean duration of symptoms was （3.5±0.7）months (range, 1 to 18 months). 2 or 3 contiguous vertebrae were involved in 15 patients, and more than 4 vertebrae were involved in 3 patients. The patients had varying degrees of paraplegia (3 with Frankel grade A, 9 Frankel B, and 6 Frankel C). The kyphotic angles were more than 45° in 12 patients before operation. The mean preoperative kyphotic angle was （48.5±7.0）° (range, 20° to 75 °).The chemotherapy course were 12-18 months and adapted individuately according to following up. The clinical outcomes were evaluated in terms of clinical manifestation, the improvement in Frankel grade, radiographical changes, and the complications of the operations. The mean follow up was (3.4±0.6) years (range:2.0 to 6.0 years).  Results All patients received follow-up. The operation time was average （5.2±0.5）h (range 4.0-7.5 h), and the bleeding was average (1400±150)ml (range 850-2000 ml). All these patients had their incision healed by first intention, no found sinus formation, vertebral tuberculous relapse. The completely neurological recovery occurred in 17 patients, The neurological function recovered from Fankel A grade to Fankel D grade in 1 patients. The average correction of kyphotic anglein the immediate postoperative period was (36.5±6.8) degrees, and the average loss of correction of local kyphosis at the final follow-up was (3.0±0.6) degrees. Bony fusion was achieved in 17 patients, 1 patient received reoperation owing to bad bony fusion and the fracture of the rods.  Conclusion Single-stage posterior circumferential decompression, interbody bony fusion and posterior instrumentation is an reasonable and effective choice in treatment of some kinds of thoracic or thoracolumbar spinal tuberculosis with paraplegia. This procedure could promote the recovery of the paraplegia through complete decompression. But it has high technical requirements and associated with greater trauma, may not be routine method in the treatment of spinal tuberculosis.

Objective To analyzed the clinical efficacy of one-stage anterior debridement with titanium cage bone graft and system internal fixation with screw rod in the treatment of thoracic spinal tuberculosis.Methods Twenty eight patients with thoracic spinal tuberculosis who were underwent surgery of one-stage anterior debridement with titanium cage bone graft and system internal fixation with screw rod in our hospital during Sep. 2009 to Dec. 2016. Twenty one patients were followed up including male in 14 cases and female in 7 cases. There was one patient with the fifth and sixth thoracic spinal involved, three patients with the sixth and seventh thoracic spinal involved, three patients with the seventh and eighth thoracic spinal involved, two patients with the ninth and tenth thoracic spinal involved, four patients with the tenth and eleventh thoracic spinal involved, two patients with the eleventh and twelfth thoracic spinal involved, one patient with the sixth, seventh and eighth thoracic spinal involved, three patients with the seventh, eighth and ninth thoracic spinal involved, and two patients with the ninth, tenth and eleventh thoracic spinal involved. According to the results of preoperative and postoperative follow-up of Frankel spinal cord injury grade, visual analogue score (VAS), Cobb angle correction of kyphosis and bone graft fusion, the clinical efficay was assessed.Results There were grade B in one case, grade C in five cases, grade D in six cases, grade E in nine cases according to preoperative Frankel grade assessment, and grade D in four cases, grade E in seventeen cases according to Frankel grade assessment in the last follow-up ranged from 10 months to seven years. The VAS was average 6.29±1.27 scores before operation, average 2.81±0.87 scores at one week after operation and average 1.24±0.89 scores at the last follow-up. The Cobb angle was average 19.81±11.08 degrees before operation, average 3.81±2.77 degrees at one week after operation and average 4.52±3.23 degrees at the last follow-up. Bone fusion was achieved in all 21 patients. The fusion time was 6.93±1.33 months ranged from 5 to 11 months. No case was found loosening, shedding and fracture of the internal fixation system at the last follow-up.Conclusion One-stage anterior debridement with titanium cage bone graft and system internal fixation with screw rod can achieve good clinical effect including effective debridement, nerve compression relieved, kyphosis correction and spinal stability reconstruction in the treatment of thoracic spinal tuberculosis.

Objective To explore the clinical effect of the nano-hydroxyapatite／polyamide 66(n-HA／PA66) composite in treating thoracolumbar spinal tuberculosis.  Methods Sixty patients (36 males, 24 female; age, 19-75 years old, averaged (42.4±10.6) years old) with thoracic or lumbar tuberculosis admitted in Guangzhou Chest Hospital from January 2012 to June 2013, which were received anterior debridement and treated by padding artificial bone by nano-hydroxyapatite/polyamide 66. Among the 60 patients, the lesion located at thoracic vertebra in 29 patients, thoracolumbar in 16 patients, upper lumbar in 15 patients; and in which 2 vertebrae were damaged in 47 patients, 3 vertebrae were damaged in 11 patients, and vertebrae were skipped damaged in 2 patients. There were 49 cases of kyphosis in the 60 patients, the average Cobb angle was (29.3±3.6)°. The erythrocyte sedimentation rate(ESR) was 35-126 mm/1 h before the operation, averaged (59.8±13.9) mm/1 h. The evaluation indicator include the Cobb angle, ESR and the neural function by Frankel system before and after the operation, and the bone graft fusion and the rate of n-HA／PA66 composite subsidence by examining the thoracolumbar anterioposterior and lateral film and the three-dimensional CT image.  Results The period of follow-up was 8-30 months (the median time 17.5 months), all the incisions healed by the first intention, there was no failure of internal fixation. The immediate postoperative average Cobb angle was (13.1±4.5)°, the last follow-up was (14.8±4.0)°, the lost of Cobb angle was (1.7±0.5)°. By the last follow-up, the spinal cord Frankel grading elevated by grade 0-2 respectively in the 31 patients who diagnosed incompletely paralysis(Frankel grade B or C or D), in which 4 patients of Frankel B preoperative 1 patients elevated 1 grade and 3 elevated 2 grade, in which 8 patients of Frankel C preoperative 3 patients elevated 1 grade and 5 elevated 2 grade, and 19 patients of Frankel D preoperative 18 patients elevated 1 grade and 1 unchanged. By the final follow-up, the E was 34 patients, the D was 23 patients, the C was 2 patients and the B was 1 patients by the bone graft fusion which was evaluated with Brantign grading criteria, the bone graft fusion rate was 95.0%(57/60), the bone graft fusion time was 4-8 months(the median time 5.5 months). The average n-HA／PA66 composite subsidence was (1.6±0.7)mm, in which 2 patients’ subsidence ＞3 mm, the rate of subsid-ence was 3.3%(2/60), there were no internal fixation shift or fracture. The time of ESR normalization was 3-7 months (the median time 4.5 months).  Conclusion The n-HA／PA66 composite has very important clinical effect in treating thoracolumbar spinal tuberculosis.

Objective

To evaluate the feasibility, clinical and radiological outcome of single-stage debridement, spinal fusion and internal fixation through a posterior approach in the surgical management of patients with pyogenic spondylodiscitis.Methods From January 2012 to December 2016, 31 inpatients (19 males and 12 females; aged 33-79 years; mean age, 60.7±11.2 years) suffering from pyogenic spondylodiscitis were included. All the patients received a single-step radical debridement of the infected intervertebral disc space, posterior screw-and-rod instrumentation and spinal fusion. Intravenous or oral antibiotics were continued for 12 weeks postoperatively and patients were followed up routinely after the operation. The lesion was located in lumbar spine in 23 patients and thoracic spine in 8 patients. There were 17 patients with neurological dysfunction before the operation, among which 15 cases of ASIA D, 1 case of ASIA C and 1 case of ASIA B. At 1, 3, 6 and 12 months after surgery, X-ray, three-dimensional CT scan and MRI were performed. The changes in pain scores (visual analogue score, VAS) and nerve function based on ASIA classification and the correction of Cobb’s angles were assessed for efficacy evaluation.Results The operation time ranged 112-300 min (mean (184.9±46.9) min). The intraoperative blood loss was 200-1400 ml (mean (537.1±286.6) ml). All patients were followed up for (42.3±15.4) months on average (ranged 12-71 months). One of the 31 patients demonstrated of recurrent infection (3.2% (1/31)). The postoperative VAS scores of pain at 3 months (3.06±1.59), 6 months (1.77±1.28), 12 months (1.03±1.22), and last follow-up (0.42±0.85) were significantly decreased when compared with preoperative score (6.74±1.13) (t values were 13.15, 19.73, 18.12, 24.73, all P values <0.05). Postoperative neurological function was improved after surgery, 16 cases were restored to ASIA E and 1 was restored to ASIA D. The preoperative Cobb’s angle was (26.4±16.8)°in thoracic spine and (31.0±3.2)° in the lumbar spine. One month after operation, these Cobb’s angles improved to (21.4±14.6)° and (21.3±5.2)°, representing mean corrections of 5.0° and 9.7° in the thoracic and lumbar spines, respectively. The differences were statistically significant (t values were 4.41, 13.09, all P values <0.05). At last follow-up, these Cobb’s angles were (22.5±15.0)° and (23.8±4.8)°, representing mean losses of 1.1°(t=3.81, P<0.05) and 2.5° (t=15.30, P<0.05) in the thoracic and lumbar spine, respectively.Conclusion Single-stage debridement, spinal fusion and internal fixation through a posterior approach is an effective and feasible surgical method for pyogenic spondylodiscitis.

Objective To evaluate the clinical effect of treatment of cervical spine osteomyelitis via single-stage anterior debridement and bone graft fusion.Methods A retrospective information of 58 cases (male 36 cases, female 22 cases,) with cervical spine osteomyelitis treated by single-stage anterior debridement and bone graft fusion from June 2010 to June 2016 was collected. The mean age of these patients was 62.7±12.4 years (range 17-79 years). There were 10 cases of suppurative cervical spondylosis, 35 cases of tuberculous cervical spondylosis, 7 cases of Brucella cervical spondylosis and 6 cases of cervical spondylosis of unknown origin. The disease controlling statues was evaluated based on laboratory result of erythrocyte sedimentation rate and C-reactive protein. Eck fusion and grading criteria were taken to evaluate the fusion of vertebral body. The clinical effects were evaluated using the Visual Analogue Scale (VAS) and the Japanese Orthopedic Association score (Cervical) of cervical function. The data were analyzed by SPSS 23.0 statistical software. The measurement data were expressed by ($\bar{x}$±s). The data of preoperative and last follow-up were compared by paired t test. P<0.05 was statistically significant.Results All of 58 cases of patients’ symptom were significantly improved. The cervical VAS score: average (5.3±0.8)points before operation, average (2.3±0.8)points,(0.9±0.5)points,(0.6±0.5)points in one month、 six months after operation and the last time follow up, respectively.The postoperative VAS score was significantly lower than that before operation(Z=-6.75, P=0.00), The JOA score: average (11.0±0.9)points before operation, average (13.6±1.0)points,(15.6±1.0)points,(15.9±0.8)points in one month、 six months after operation and the last time follow up, respectively. The postoperative JOA score was significantly lower than that before operation (t=-51.10,P=0.00). All patients were not found internal fixation loosening and fracture in the follow-up period. 5 patients had hoarseness after operation, follow-up observation after a month of recovery. 2 patients with pyogenic infectious occurred wound infection two weeks after operation and recovery by re-debridement. Conclusion Cervical spine osteomyelitis treated by single-stage anterior debridement and bone graft fusion had a definite curative effect which can completely remove the lesionand remove the nerve compression.

Objective To explore the long-term effect of retrograde resistance exercise on postoperative rehabilitation of middle-aged and elderly patients with spinal tuberculosis complicated with osteoporosis.Methods From May 2014 to September 2016, 108 cases of middle-aged and old patients with spinal tuberculosis complicated with osteoporosis were admitted to the Spinal Minimally Invasive Department of the Eighth Medical Center of PLA General Hospital (the 309th Hospital of PLA), among whom 40 cases were selected randomly (control group). From October 2016 to May 2018, 92 middle-aged and old patients with spinal tuberculosis complicated with osteoporosis were admitted to the same department, among whom 40 patients were selected randomly (observation group). In the control group, the patients received routine functional exercise after the debridement and bone graft fixation, and patients of the observation group received retrograde resistance exercise by wearing a brace in the condition that the plate was well fixed by CT examination on the 14th day after the surgery. Disability index (ODI), intervertebral bone graft block total integration, functional recoveryⅠlevel degree, bone mineral density (BMD) of the right femoral neck were compared between the two groups of patients after 1 month, 3 months and 6 months discharged from hospital.Results The ODI of the patients of observation group were (10.35±3.26), (8.86±2.94) and (6.78±2.84) respectively after 1 month, 3 months and 6 months discharge, which were significantly lower than those of the control group ((12.34±3.56), (10.95±3.12) and (8.94±2.76) respectively) (t=2.607, 3.083, 3.449, P=0.005, 0.001, 0.000). The numbers of patients with the intervertebral bone graft fusion of recorery Ⅱ level in observation group were 5 (12.5%), 30 (75.0%) and 40 (100.0%) after 1 month, 3 months and 6 months respectively, which were significantly higher than those in control group (0 (0.0%), 20 (50.0%) and 34 (85.0%) respectively) (χ ²=5.333, 5.333, 6.486, P=0.021, 0.021, 0.011). The numbers of patients with the function of recovery I level in observation group were 5 (12.5%), 15 (37.5%) and 35 (87.5%) respectively, which were also significantly better than those in control group (0 (0.0%), 6 (15.0%), and 26 (70.0%)) (t=5.333, 5.230, 5.591, P=0.021, 0.022, 0.018). The BMD of the right femoral neck in observation group were (0.45±0.02)g/cm ², (0.47±0.02)g/cm ² and (0.47±0.03)g/cm ² respectively after 1 month, 3 months and 6 months, which were lower than those of control group ((0.46±0.01)g/cm ², (0.46±0.03)g/cm ², (0.46±0.02)g/cm ²)). There were significant differences of BMD of the right femoral neck after 3 months and 6 months between the two groups (t=1.701, 1.682, P=0.046, 0.048). Conclusion The intervention of retrograde resistance movement is conducive to postoperative functional recovery, complete fusion recovery of intervertebral bone grafts, and increase of bone density in the right femoral neck, and in order to promote the recovery of patients.

Objective To investigate the effect and value of one stage debridement and internal fixation of bone combined with drainage on treating non-specific primary thoracolumbar infection.Methods The pre- and post-operation clinical data were collected from 46 patients with primary thoracolumbar non-specific infection admitted in the department of orthopedics of the Chest Hospital of Hebei Province from July 2012 to June 2016. Those patients included 4 cases with infection in thoracic, 5 cases in thoracolumbar, 33 cases in lumbar, and 4 cases in lumbosacral. All patients received anti-inflammatory treatment for 2 to 4 weeks before operation. One stage debridement and internal fixation of bone combined with drainage was conducted. The average drainage time after operation was (14.0±4.3) days, ranged from 3 to 28 days. Pain relief, infection control situation, time to getting the patient out of bed after surgery, recovery of neurological function, and bone graft fusion were observed, and the efficacy was evaluated.Results Among the 46 cases in this study, 15 cases were bacterial culture positive, with a positive rate of 32.6%. The visual analogue scale (VAS) score at the third week was (2.59±0.20); compared with preoperative (7.09±0.25), the difference was statistically significant (t=11.35, P<0.05). The erythrocyte sedimentation rate (ESR) at the third week after operation was (43.30±3.13) mm/1 h; compared with preoperative (65.98±4.56 mm/1 h), the difference was statistically significant (t=5.45, P<0.05). The C-reactive protein (CRP) at the third week after operation was (17.15±1.10) mg/L; compared with preoperative (34.54±2.43 mg/L), the difference was statistically significant (t=9.63, P<0.05). One case received a second surgery, and the second surgery rate was 2.2% (1/46). Postoperative, the mean time of patients wearing a brace out of bed was (12.6±4.7) days, ranged from 5 to 21 days. Among the 12 patients with preoperative spinal cord nerve dysfunction, American Spinal Injury Association (ASIA) grade recovered form Grade A to Grade B in 1 case, and form A to C in 1 case, from B to C in 1 case, from B to D in 1 case, from C to D in 3 cases, and from C to E in 5 cases. The fusion time of interbody bone graft ranged from 3 to 12 months in 46 cases, and the mean fusion time was (7.6±1.8) months. According to the fusion standards, 35 cases were excellent, 9 were better, and 2 were good, resulting in an excellent and better rate of 95.7% (44/46).Conclusion For patients with non-specific primary thoracolumbar infection who has surgical indication, one stage debridement and internal fixation of bone combined with drainage is safe and feasible. It has the advantages of rapid infection control, pain relief, neurological recovery, and early ambulation and is an effective method in treating non-specific primary thoracolumbar infection.

Objective To investigate the value of GeneXpert MTB/RIF (GeneXpert) and line probe assay for rapid diagnosis of osteoarticular tuberculosis and detection of rifampicin resistance. Methods A total of 172 suspected osteoarticular tuberculosis patients who received focal cleaning or paracentesis between March to December 2018 were selected. GeneXpert, line probe assay and BACTEC MGIT 960 mycobacterial culture were used to test the samples. Using clinical comprehensive diagnosis as the reference standard, the efficacy of GeneXpert, linear probe assay and combination of the two methods in diagnosis of osteoarticular tuberculosis were evaluated. Using mycobacterial culture drug sensitivity test as the reference standard, the efficacy of GeneXpert, linear probe assay and combination of the two methods in detecting rifampicin resistance were evaluated. Results According to the clinical comprehensive diagnosis of the 172 suspected osteoarticular tuberculosis patients, 112 were diagnosed with osteoarticular tuberculosis, whereas 60 were non-tuberculosis. Using clinical comprehensive diagnosis as the reference standard, the sensitivity and specificity of GeneXpert were 82.14% (92/112) and 96.67% (58/60). The results of GeneXpert was consistent with that of clinical comprehensive diagnosis (Kappa=0.74). The sensitivity and specificity of line probe assay were 69.64% (78/112) and 90.00% (54/60). The consistency with clinical comprehensive diagnosis was not good (Kappa=0.54). The sensitivity and specificity of combination of the two methods were 82.14% (92/112) and 90.00% (54/60). The combination method had good consistency with clinical comprehensive diagnosis (Kappa=0.68).The area under the receiver operating characteristic (ROC) curve of GeneXpert, line probe assay and combination of the two methods were 0.89, 0.80 and 0.86, respectively, indicating good diagnosis performance. Using mycobacterial culture drug sensitivity test as the reference standard, the sensitivity and specificity of GeneXpert in inspection to rifampicin resistance were 100.00% (18/18) and 92.31% (24/26), the results was highly consistent (Kappa=0.91), and the area under the ROC curve was 0.96. The sensitivity and specificity of line probe assay in inspection to rifampicin resistance were 100.00% (18/18) and 88.46% (23/26), the results was highly consistent (Kappa=0.86), and the area under the ROC curve was 0.94. The results of combination of the two methods was consistent with that of the linear probe assay. Conclusion GeneXpert and line probe assay can rapidly and accurately diagnose osteoarticular tuberculosis and detect rifampicin resistance, having good clinical application value.

Objective To investigate the clinical application value of a new type of hydroxyapatite bone cement composite anti tuberculosis (TB) drugs and titanium mesh internal fixation for treatment of patients with spinal TB.  Methods Fifty patients with spinal TB who were treated by using the new hydroxyapatite bone cement composite anti-TB drugs and titanium mesh internal fixation at Jilin Provincial TB Hospital from January 2011 to January 2014 were enrolled in our study. Among those patients, 23 cases were male and 27 cases were female; the tuberculous lesions were located in the thoracic spine in 28 cases and lumbar spine in 22 cases; according to the USA Spinal Injury Association (ASIA) Classification, preoperative neurological function was Grade A in 1 patient, Grade B in 1 patient, Grade C in 6 patients, Grade D in 9 patients and Grade E in 33 patients. Before surgical operation, all those patients received anti-TB chemotherapy with the treatment regimen 3HRZE/9-15HRE for 2 weeks; the postoperative evaluations were done at the second week after patients received operations and every three months after patients were discharged from the hospital, and the evaluation was based on imaging examination results, clinical symptoms, intervertebral fusion, spinal deformity degree and neurological classification, etc.  Results All patients were followed up for mean (20±8) months (12-36 months). There were no postoperative deaths, no serious da-mages of spinal nerves, large blood vessels and important organs, no complications. Vertebral pain disappeared in all patients and the excellent and good rate of intervertebral fusion (Level Ⅰ±Level Ⅱ) was 94.0%(47/50), kyphosis instant correction was a mean (20±0.7) degrees and the average loss was (1.2±0.3) degrees in the last follow-up while the average loss was (0.5±0.2) degrees after internal fixation removal. The ASIA Classification was Grade E in all 50 patients after operations. All patients could walk in 1-2 weeks after operations. In total, the cure rate was 100.0% (50/50).  Conclusion The new hydroxyapatite bone cement composite anti-TB drugs and titanium mesh internal fixation has been confirmed by our study to be an effective method for treatment of patients with spinal TB and make patients rapid postoperative recovery.

Objective To evaluate the clinical efficacy of one-stage anterior debridement, bone grafting fusion and posterior cortical bone trajectory (CBT) screw fixation in combination with traditional pedicle screw internal fixation in lumbar single-segment instumentation for the treatment of monosegment lumbar spinal tuberculosis.Methods From January 2015 to January 2016, 42 patients with monosegment lumbar spinal tuberculosis in the First Affiliated Hospital of the Air Force Military Medical University of PLA were included in this analysis. All patients were divided into two groups based on the posterior internal fixation technique that was applied according to patient’s clinical situation and wish. Internal fixation was performed by CBT screws combined with traditional pedicle screws in 21 patients (A group) and by traditional pedicle screws in 21 patients (B group) after anterior debridement and bone grafting fusion. The Cobb angle, the Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and visual analogue score (VAS) value of all patients were analyzed before and after surgery and during the follow-up period.Results Forty-two patients were followed-up from 18 to 30 months, with an average follow-up time of (24.1±4.5)months. Three months after surgery, the ESR, CPR and VAS were (13.5±5.5)mm/1h, (4.7±2.0)mg/L and (1.9±0.8) in group A and (12.9±4.9)mm/1h, (5.2±3.2)mg/L and (2.2±1.0) in group B, respectively. The differences were not statistically significant (t=0.32, -0.68 and -1.02; P=0.747, 0.500 and 0.312). The average correction degree and correlation loss of Cobb angle were (11.6±6.3)° and (1.7±1.2)° in group A and (9.9±5.9)° and (1.4±1.1)° in group B at the last follow-up, with no significant statistical differences (t=0.96 and 0.94; P=0.343 and 0.355). As to postoperative neurological improvement, 1 case with Frankel grade B before operation recovered to grade D; of the 5 cases with grade C before operation, 4 cases recovered to grade D and 1 case recovered to grade E; of the 26 cases with grade D before surgery, all recovered to grade E.Conclusion For patients with monosegment lumbar spinal tuberculosis, CBT screw fixation technique can fix and fuse the diseased single-segment and retain normal movement of the adjacent spinal column. It is indicative to monosegment lumbar spinal tuberculosis.

Multiple sites of osteoarticular tuberculosis combined with multiple cutaneous tuberculosis is very rare and difficult to be early diagnosed. One patient with multiple tuberculosis of bone and joint with multiple skin tuberculosis was reported, who was diagnosed and treated via collaborations of multiple related departments. In order to enhance clinicians’ knowledge and raise up their awareness to atypical multiple osteoarticular tuberculosis and complicated with skin tuberculosis, this paper conducted deep analysis and discussion on clinical diagnosis and treatment process of this patient. Meanwhile, it is helpful to improve clinicians’ abilities of TB diagnosis and treatment, which will bring benefits to the patients on early diagnosis and early treatment.

Bone and joint tuberculosis is a serious infectious disease endangering people’s health. Nearly 95% are secondary tuberculosis of elsewhere. Most of patients suffering from tuberculosis of bones and joints will be di-sabled. And this disease will seriously affectpeople’s health, work and life. Since the founding of new China, the diagnosis and treatment of bone and joint tuberculosis has made great progress. However, today, due to various reasons, academic development is subject to certain constraints. There is a discrepancy between the progress of the bone and joint tuberculosis and the whole medicine system in our country. Look back to the past and look forward to the future, we need to review the the diagnosis and treatment of bone and joint tuberculosis, strive to promote the scientific development of the bone and joint tuberculosis treatment technology.

Objective To explore the feasibility and clinical efficacy of debridement, bone graft fusion and internal fixation with one-stage operation in the treatment of advanced wrist joint tuberculosis. Methods The clinical data from 14 patients with advanced tuberculosis of wrist joint treated with debridement, bone graft fusion and internal fixation were analyzed retrospectively in Shandong Provincial Chest Hospital Affiliated to Shandong University from April 2010 to May 2017. Among them, 11 cases were male and 3 cases were female, the average age was (41.0±18.5) years old ranged from 7 to 85 years old. The pericarpal focus was completely debrided in all patients, the bone defect was implanted into allogeneic bone, microtitanium plate was placed on the radius and metacarpal for internal fixation, and the distal ulna about 1 cm was removed at the same time. All patients underwent systematic and standardized chemotherapy with anti-tuberculosis drugs for 12 months. The healing of surgical incision, complications, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were analyzed. The functional recovery of wrist joint were analyzed using the score table of Buck-Gramcko/Lohmannn (scoring criteria: 9-10 scores was excellent, 7-8 scores was good, 5-6 scores was general, low than 5 scores was poor) and upper limb dysfunction (DASH table: 0 score was normal and 100 scores was extremely limited). Results The average time of follow-up was (14.0±2.1)months ranged from 12 to 18 months in all patients. Surgical incision was healing with one-stage in all patients. The ESR was decreased from (28.0±23.5)mm/1h to (6.1±2.1)mm/1h with which the average recovery time of ESR was (3.5±1.3)months ranged from 2 to 6 months. The CRP was decreased from (27.0±35.1)mg/L to (3.4±1.3)mg/L with which the average recovery time of ESR was (2.4±1.2)months ranged from 2 to 5 months. The score was increased from average (4.6±0.8) ranged from 3 to 6 before operation to (8.5±0.9) ranged from 7 to 10 after operation with the score table of Buck-Gramcko/Lohmannn. The assessment was improved satisfactory from poor in all patients before operation to excellent in 7 patients and good in the other 7 patients after operation. The score with DASH table was improved from the average (68.0±1.9) ranged from 65 to 70 to the average (30.0±2.8) ranged from 26 to 35 in all patients. All patients had good internal fixation position, no swelling and pain, and no complications at the follow-up. Conclusion The better clinical efficacy can achieved with debridement, bone graft fusion and internal fixation with one-stage operation based on effective chemotherapy in the treatment of advanced wrist joint tuberculosis.

From January 2006 to January 2015, 45 patients with thoracolumbar tuberculosis treated with one stage anterior debridement, titanium mesh-bone graft fusion and posterior internal fixation in the First People’s Hospital of Yidu in Hubei province were included in this analysis. Among them, 20 cases were males, and 25 were females. They aged from 23 to 72 years old, with an average age of (46.02±10.13) years. There were 20 cases with thoracic tuberculosis, 10 cases with thoracolumbar spinal tuberculosis, 8 case with lumbar vertebral tuberculosis, and 7 cases with lumbosacral tuberculosis. The operation time, intraoperative blood loss, visual analogue scale (VAS) score, Frankel grade, angle of kyphosis, and erythrocyte sedimentation rate (ESR) before and after surgery were evaluated, as well as complications and bone graft fusion status. The average operation time of the 45 patients was (230.27±15.86)min, and the intraoperative hemorrhage was (489.89±35.87)ml. The preoperative VAS score was (7.50±1.13), and it decreased to (0.89±1.67) 3months after operation. The difference was statistically significant (t=22.23, P<0.001). As to postoperative neurological improvement, of the 7 cases with Frankel grade B before surgery, 4 cases recovered to grade E and 3 cases recovered to grade D; of the 8 cases with grade C and 15 cases with grade D before operation, all recovered to grade E. Preoperative kyphosis angle was (33.93±7.01)°, while the kyphosis angle was reduced to (15.07±3.45)° 3months after the operation; the difference was statistically significant (t=16.20, P<0.001). ESR decreased from (69.75±14.62)mm/1h before surgery to (13.16±5.27)mm/1h 3months after surgery; the difference was statistically significant (t=23.81, P<0.001). The 45 patients were followed up for 24-70months. No serious complications occurred after operation, bone graft was fused in all patients, and no internal fixation loosening and fracture appeared. Hence, we concluded that the one stage anterior debridement, titanium mesh-bone graft combined with posterior internal fixation for patients thoracolumbar spinal tuberculosis can effectively correct spinal deformity, reconstruct spinal stability, and improve the cure rate of spinal tuberculosis.

Objective To understand the clinical characteristics of osteoarticular tuberculosis (TB) in pediatric patients and to provide reference for developing prevention and treatment strategy.Methods The clinical information and data of 177 children with osteoarticular tuberculosis admitted to the West China Hospital of Sichuan University from 2013 to 2017 were collected, including the number of cases admitted each year, sex and age distribution, lesion location of tuberculosis, source and area of the patients. Their clinical characteristics were analyzed.Results From 2013 to 2017, a total of 177 children with osteoarticular tuberculosis were admitted to the West China Hospital of Sichuan University and 143 cases out of them were from Sichuan Province. The average number of hospitalized patients each year was 35.4 cases; 111 patients were male while 66 patients were female, and the ratio of male to female was 1.68∶1; the age of the patients ranged from 1 year to 14 years with an average of 6.4±3.6 years, and the age-group distribution of the patients was as follows: the proportion of infant and before school age (1-6 years old) was 56.5% (100/177), school age (7-12 years old) was 37.3% (66/177) and aged 12 years old and above was 6.2% (11/177). The hip joint was the most commonly affected (59 cases), then followed by spine (54 cases), knee joint (42 cases) and ankle joint (10 cases). The number of the patients who were from Liangshan Yi Autonomous Prefecture, Ganzi Tibetan Autonomous Prefecture, Aba Tibetan Autonomous Prefecture and other areas in Sichuan Province accounted for 50.3% (72/143), 13.3% (19/143), 11.2% (16/143) and 25.2% (36/143), respectively.Conclusion The pediatric patients with osteoarticular tuberculosis admitted to the West China Hospital of Sichuan University are mainly from Liangshan Yi Autonomous Prefecture, Ganzi Tibetan Autonomous Prefecture and Aba Tibetan Autonomous Prefecture in Sichuan Province, so those areas are priority on early prevention and treatment of bone and joint TB. Furthermore, most of the pediatric patients with osteoarticular TB are young children, which is the key group population for TB prevention and screening.

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.

Hematogenous disseminated tuberculosis is a kind of severe tuberculosis. With hysteresis imaging performances, the symptoms are often untypical, it is difficult to diagnose early. MDS is malignant,without specific clinical manifestations and abnormal performance of the blood system. A case of disseminated tuberculosis complicated with severe hematogenous cell loss in our hospital in April 2017 was reported. The patient presented with “dizziness and fatigue for 3 months, fever for 2 month”was firstly treated with anti-tuberculosis treatment, and then the clinical symptoms, pulmonary lesions and the performance of the blood system improved. The pulmonary lesions were further improvingd, while the blood system abnormalities were aggravated again. Finally, the blood disease was diagnosed as MDS with repeated bone marrow examination. This report aimed to improve the diagnosis and share treatment experience of disseminated tuberculosis complicated with MDS.