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Table of Content

    10 March 2015, Volume 37 Issue 3
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    • Analysis on efficacy of surgical treatment in patients with focus-active thoracic vertebral tuberculosis combined with para-plegia
      YAN Guang-xuan, QIN Shi-bing, DONG Wei-jie, LAN Ting-long, FAN Jun, TANG Kai, LI Yuan, XU Shuang-zheng
      Chinese Journal of Antituberculosis. 2015, 37(3):  223-229.  doi:10.3969/j.issn.1000-6621.2015.03.002
      Abstract ( 1547 )   PDF (1717KB) ( 537 )   Save
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      Objective To investigate the efficacy of surgical treatment in patients with focus-active thoracic vertebral tuberculosis combined with paraplegia and the impact of paraplegia time on neurological function recovery.  Methods From Jan 2011 to Jan 2014, 67 patients with focus-active thoracic vertebral tuberculosis combined with paraplegia had taken in surgical treatment in the department of orthopedics of Beijing Chest Hospital, Capital Medical University. All the patients were followed up by clinical and radiography for an average period of 14 (12－28) months. And all of them had taken in surgical treatment after received preoperative chemotherapy for more than 2 weeks, and the toxic symptom alleviated. The clinical outcomes of the surgical treatment was analyzed by visual analogue scale (VAS), Cobb angle, paraplegia time and ASIA scale. The Cobb angle and the VAS score were analyzed by the Paired Samples t test. The Wilcoxon test was applied to analyze the differences of ASIA scale between before operation and the final follow-up. The ordinal logistic test was used to analyze the correlation of the paraplegia time and the ASIA scale at the final follow-up.  Results The Cobb angle (23.18±12.07)° had satisfactory improvement at 3 weeks after operation (14.92±9.12)° and at the final follow-up (16.45±9.18)°, t:3.58 and 2.99,P<0.05. The VAS (6.83±1.40) also improved significantly at 3 weeks after operation (3.42±0.99) and at the final follow-up (1.75±0.62), t:10.92 and 11.70, P<0.05.The ASIA scale showed significant difference between one day before operation and the final follow-up by the Wilcoxon test (A scale in 3 patients, B scale in 10 patients, C scale in 33 patients, D scale in 21 patients one day before the operation, and A scale and B scale in 0 patients, C scale in 3 patients, D scale in 6 patients, E scale in 58 patients at the final follow-up), Z=7.246，P<0.05. The average paraplegia time was (7.87±4.90) (1 to 24) weeks. The final ASIA scale showed uncorrelated with the para-plegia time by the ordinal logistic test (β=0.051, χ2=0.269, P=0.604). All the 67 cases had achieved rigid bony fusion, the average time was (3.81±1.43) (3 to 6) months. And there was no recurrence case.  Conclusion The debridement, decompression and internal fixation surgery can achieve well clinical efficacy and recovery of neural function in the patients with focus-active thoracic vertebral tuberculosis combined with paraplegia. The paraplegia time had no significant effect on the neurological recovery.
      The indications and results of single-stage posterior circumferential decompression and posterior instrumentation in treatment of spinal tuberculosis associated with paraplegia
      XUE Hai-bin, GU Su-xi, ZHANG Cong, GAO Tian-jun, JIAN Wei
      Chinese Journal of Antituberculosis. 2015, 37(3):  230-236.  doi:10.3969/j.issn.1000-6621.2015.03.003
      Abstract ( 1498 )   PDF (2453KB) ( 375 )   Save
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      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.
      Perioperative management of spinal tuberculosis with paraplegia
      FAN Jun, QIN Shi-bing, DONG Wei-jie, LAN Ting-long, XU Shuang-zheng
      Chinese Journal of Antituberculosis. 2015, 37(3):  237-242.  doi:10.3969/j.issn.1000-6621.2015.03.004
      Abstract ( 1500 )   PDF (872KB) ( 385 )   Save
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      Objective  To investigate the experience in perioperative management of spinal tuberculosis with paraplegia. Methods A retrospective analysis was conducted. The clinical information from 183 patients with spinal tuberculosis and paraplegia who stayed and got treatment at Orthopedics Department of the Beijing Chest Hospital from January 2009 to October 2014 was analyzed, including complications during perioperative period and management methods, treatment outcomes of surgical operations. Among those patients, 76 cases were male and 107 cases were female; the average age was（52.2±17.2） years old (range 2-87 years). SPSS 17.0 software was used for statistic analysis of the data related to patients’ nerve function, degree of pain and angle of kyphosis before and after operation. The t-test was used for comparisons between two groups and P<0.05 was regarded as statistically significant difference. Results One hundred and forty patients out of 183 enrolled patients had preoperative complications, mainly including pulmonary tuberculosis (65 cases), diabetes (31 cases), high blood pressure (24 cases), etc.; after operations, the common postoperative complications in patients were hypoalbuminemia (98 cases), anemia (69 cases), hypokalemia (26 cases), sinus tract (14 cases), cardiac insufficiency (9 cases), arrhythmia (6 cases), etc. All patients safely passed the perioperative period under appropriate management. In the perioperative period, nerve function of the patients were evaluated according to the International Standards for Neurological Classification of Spinal Cord Injury (revised 2011) published by the American Spinal Injury Association (ASIA), and the results showed that the nerve function in 164 patients improved 1-2 levels. All patients’ kyphosis angles were corrected satisfactory from (19.2±6.3)° (preoperative Cobb Angle) to (6.2±2.5)° (postoperation Cobb angles), and it was a significantly deference (t=6.956, P<0.05). The pain was measured by using the visual analogue scale (VAS), and the results showed a significant decrease in pain scores from preoperative values of (7.4±1.3) points to postoperative values of (2.2±0.3) points (t=8.964, P<0.05).  Conclusion Spinal tuberculosis patients with paraplegia had more complications before and after surgical operations, so it is an important guarantee of successful operations to conduct correct assessments and appropriate management in those patients during perioperative period.
      Study on clinical treatment of patients with spinal tuberculosis by using new hydroxyapatite bone cement composite anti-TB drugs and titanium mesh internal fixation
      WANG Zhong-ji，LU Xu，YU Jing-lai，LI Li，XIA Yun-feng，WANG Xue-bing
      Chinese Journal of Antituberculosis. 2015, 37(3):  243-248.  doi:10.3969/j.issn.1000-6621.2015.03.005
      Abstract ( 1377 )   PDF (1857KB) ( 303 )   Save
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      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.
      Clinical efficacy of treatment 60 cases of thoracic and lumbar spinal tuberculosis with Nano-hydroxyapatite/polyamide 66 composite bone filling material
      XU Zu-yuan, ZHANG Qiang, FANG De-jian, ZHONG Xin
      Chinese Journal of Antituberculosis. 2015, 37(3):  249-255.  doi:10.3969/j.issn.1000-6621.2015.03.006
      Abstract ( 1256 )   PDF (2839KB) ( 350 )   Save
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      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.
      Clinical analysis of operation treatment of cervical tuberculosis (a report of 29 cases)
      SHI Shi-yuan, LAI Zhen, FEI Jun, HU Sheng-ping
      Chinese Journal of Antituberculosis. 2015, 37(3):  256-260.  doi:10.3969/j.issn.1000-6621.2015.03.007
      Abstract ( 1465 )   PDF (1714KB) ( 429 )   Save
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      Objective To evaluation of the clinical efficacy of operation for 29 patients with cervical spine tuberculosis. Methods From 2005 January to 2012 January, 29 patients with cervical tuberculosis were treated by operation treatment in department of orthopedics in the Red Cross Hospital in Hangzhou. There were male 12 cases, female 17 cases, mean age (46.0±3.2) years old(25-81 years old), upper cervical tuberculosis (C1-2) in 5 cases, lower cervical spine tuberculosis (C3-7) in 24 cases, 18 cases complicated with spinal cord dysfunction. Underwent CT and MRI examination before operation, the lesions have obvious dead bone abscess. Preoperative administration of anti-TB chemotherapy, to improve the situation, tuberculosis symptoms of poisoning and spinal cord function bone fusion and lesion healing observed after operation. Results All patients were completed the operation successfully, the wound healed in phase I, tuberculous sinus was formatted in 1 patient 2 months after operation, sinus was healed 1 month later. Two cases of recurrent laryngeal nerve injury, through to the neurotrophic treatment, hoarseness disappeared after 3 month. Operation specimens(tuberculous granuloma and abscess) were taken in 29 patients, Mycobacterium tuberculosis culture positive in 5 cases 17.24%(5/29). Postoperative follow-up was 18-36 months, 18 cases complicated with spinal cord dysfunction had different degree of recovery in 12 months follow-up. According to ASIA classification, Grade A in 2 cases recovered to grade C; B level of 10 patients recovered to grade D in 3 cases, grade E in 7 cases; C level of 6 patients recovered to grade D in 3 cases, grade E in 3 cases. The average time of bone graft fusion was (4.5±0.4) months in patients with untreated, retreatment patients bone graft fusion time was (4.7±0.6) months in average.  Conclusion Surgical operation can remove the lesion of pus and necrotic tissue, reconstruct spinal stability, and promote the recovery of neurological function. It is the effective method to treat cervical tuberculosis; Anti-TB chemotherapy standardization, sufficient preoperative and reasonable operation mode selection are an important guarantee for the success of treatment.
      Phased systematic rehabilitation on the curative effect of spinal tuberculosis with early-onset paraplegics
      LI Da-wei, MA Yuan-zheng, HU Ming
      Chinese Journal of Antituberculosis. 2015, 37(3):  261-265.  doi:10.3969/j.issn.1000-6621.2015.03.008
      Abstract ( 1550 )   PDF (863KB) ( 399 )   Save
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      Objective To investigate the rehabilitation of spinal tuberculosis complicated with early-onset paraplegia, and evaluate the clinical outcome of systematic phased rehabilitation.  Methods From March 2008 to April 2013, we retrospectively analyzed 85 patients with spinal tuberculosis complicated with early-onset paraplegia. Among them, 46 patients were male, and 39 patients were female. The average age was 41.8±17.3, range from 13 to 73 years old. Based on post-operation systematic phased rehabilitation or conventional rehabilitation therapy,they were divided into two groups, the observation group (43 cases) using a phased systematic rehabilitation, that is, perioperative rehabilitation, early rehabilitation in Grade 3A hospital,the late family or Grade 2A hospital rehabilitation; control group (42 cases) received conventional rehabilitation. Functional assessment was made according to Modified Barthel Index (MBI), and motor examination was done according to American Spinal Injury Association(ASIA2000). All the patients were followed up clinically and radiologically for an average period of 36.2 (12－60) months.  Results At the final follow-up, all the patients had achieved rigid bony fusion according to X-ray and CT examination. There were no relapse patients. In the pre-operation, post-operation and final follow-up points, the VAS score were（7.9±1.2,2.3±0.4,2.2±0.5）in observational group versus (7.8±1.3,3.1±0.8,2.9±0.7）in the control group. In comparison with pre-operational point, t value for post-operation and final follow-up points in observation group were 29.031,28.752；and 19.955,21.508 in the control group;P<0.05, Cobb angles were（30.1±3.2,11.4±2.1,11.7±2.3；29.4±4.0,10.8±2.3,10.9±2.4）respectively in the pre-operation, post-operation and final follow-up points in the observation group and control group respectively. In comparison with pre-operational point, t value for post-operation and final follow-up points in observation group were 32.037，30.617; 26.125,25.702 in the control group; P<0.05. For MBI, the scores for observation group were 41.2±10.7,69.6±15.8,93.5±14.7 versus 42.3±12.6,70.5±13.9,87.1±13.2 in the control group. In comparison with pre-operational point, MBI had satisfactory improvement at post-operation and final follow-up points（t=－9.759,－18.862 in observation group; -9.741,-15.910 in the control group; P<0.05）. MBI was statistically different between groups 6 months after operation（t=2.110,P<0.05）. The neurological status began to recover 1－17 days after the surgery. From 3 months after the surgery to the final follow-up point, in observation group 36 patients recovered fully,4 patients had partial recovery, and 3 patients had no recovery. In control group 37 patients had complete recovery, 2 patients had partial recovery, and 3 patients had no recovery.  Conclusion For early-onset paraplegia, systematic phased rehabilitation had a better therapeutic effect than conventional rehabilitation.
      Effects of surgical treatment of debridement and bone grafting fusion with internal fixation in elder thoracic spinal tuberculosis patients with paraplegia
      GUO Chun-sheng, LIU Sheng-chun, CHEN Kai, CUI Yue-hui, JIANG Guang-qing, ZHANG Hui, LI Zhao-wei
      Chinese Journal of Antituberculosis. 2015, 37(3):  266-270.  doi:10.3969/j.issn.1000-6621.2015.03.009
      Abstract ( 1469 )   PDF (1106KB) ( 421 )   Save
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      Objective To investigate the effects of surgical treatment for elder thoracic spinal tuberculosis (TB) patients with paraplegia by using the same approach of the debridement and bone grafting fusion with internal fixation.  Methods From February 2012 to October 2013, a total of 26 elder patients (aged over 60 years old) with thoracic spinal TB and paraplegia were treated at Shenyang Chest Hospital by using the same approach of the debridement and fusion with internal fixation surgical treatment. Among them, 18 patients were male and 8 patients were female; the average age was (64.4±5.1) years old; the duration of TB treatment was 5-17 months with an average of (12.4±4.2) months. The Frankel grading method and the American Spinal Injury Association (ASIA) function scale were used for grading spinal injury severity of the patients and the results were: Grade B in 17 cases, Grade C in 7 cases, Grade D in 2 cases. The erythrocyte sedimentation rate (ESR) of the patients was (62.7±6.5) mm/1 h and the Cobb angle was (24.4±3.1)°. The patients were followed up after they received surgical operations and the following information was collected: symptoms improvement, the time of vertebral lamina bone graft fusion, the Frankel grading and the Cobb angle.  Results The postoperative follow-up duration for those 26 patients was 6-12 months with an average of （11.3±2.7） months. The intercostal pain disappeared in 7 patients who suffered it before operations. The time of vertebral lamina bone graft fusion was about 6-8 months. The Frankel grading of 26 patients with paraplegia after 1 year of operations was: Grade D in 1 patient and Grade E in the remaining 25 patients. After a week of the operation, the Cobb angle was corrected to (19.3±4.3)° from (24.4±3.1)°. During the follow-up period, no internal fixation loosening or broken were observed.  Conclusion The treatment outcomes of surgical treatment with the same approach of the debridement and bone grafting fusion with internal fixation among elder thoracic spinal TB patients with paraplegia are satisfied. It may be a good option for surgical treatment in those patients.
      Operation timing and therapeutic efficacy of the spinal tuberculosis with paraplegia in the elderly
      LI Yuan, QIN Shi-bing, DONG Wei-jie, FAN Jun, LAN Ting-long, TANG Kai, YAN Guang-xuan
      Chinese Journal of Antituberculosis. 2015, 37(3):  271-275.  doi:10.3969/j.issn.1000-6621.2015.03.010
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      Objective To investigate the operation timing and therapeutic efficacy of the spinal tuberculosis with paraplegia in the elderly.  Methods From January 2005 to January 2013, medical records of 64 spinal tuberculosis patients with paraplegia in the elderly were analyzed retrospectively. Among them, 28 patients were male and 36 patients were female. The average age was (69.9±6.8) (60 to 82) years old. All patients were received preo-perative chemotherapy for (29.6±10.9) (14 to 56) days. Preoperative ASIA grades were B in 6 cases, C in 15 cases and D in 43 cases. The average preoperative paraplegia time was (5.4±3.3) (2 to 16) weeks. Fifty-seven patients had complications. All the factors above were analyzed whether operation timing and therapeutic effect were affected. All the statistical analyses were conducted with SPSS software(version 19.0),data presented as “x±s”.A student’s t-test was used to compared the difference of continuous measurements, and a P valve＜0.05 was considered statistically significant difference.  Results Sixty-four patients survived through the preoperative period. Thirty-seven patients had postoperative complications, 16 of 37 patients with postoperative complications were related with operation directly. The reasons of the postoperative complications were the advanced age of patients and the long-term bed rest caused by paraplegia. The average score of preoperative VAS was (7.2±1.3), and the average score of postoperative VAS was (2.2±1.2).The average improvement score of VAS was (5.0±2.3).The difference was statistically significant（t=12.270，P<0.05） after operation. The average improvement of ASIA was (1.2±0.5) grade after operation. The paraplegia did not improved in 4 cases for the spinal cord compressed before and behind. Bone grafts was fused in 61 cases. Average time of union was (4.8±1.3) (3 to 7) months. The average of preoperative Cobb angle was (33.4±11.3) degree,and the average of postoperative Cobb angle was changed to (16.1±6.7) degree.The average improvement of Cobb angle was (17.3±3.6) degree.The difference was statistically significant(t=5.248，P<0.05).The average follow-up time was (16.1±1.8) (12 to 18) months. Two patients relapsed for taking anti-tuberculosis drugs irregularly after operation.  Conclusion The operation is safety for patients with paraplegia in the elderly when preoperative chemotherapy time is ≥2 weeks, preoperative paraplegia time is shortened as possible and complications is controlled.The pain, ASIA grade and Cobb angle are improved obviously after operation.
      The perioperative nutritional status survey of 132 cases of patients with spinal tuberculosis
      LEI Guo-hua, MA Jiao-jie, WANG Qian, CAO Yan-hua, WANG Xiu-hua
      Chinese Journal of Antituberculosis. 2015, 37(3):  276-279.  doi:10.3969/j.issn.1000-6621.2015.03.011
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      Objective To understand perioperative nutritional status in patients with spinal tuberculosis, in order to provide targeted nutritional intervention. Methods One hundred and thirty-two cases of spinal tuberculosis patients hospitalized between Jan-Oct. 2014 in Beijing Chest hospital were investigated. Patients received nutrition risk assessments (nutrition risk screening, NRS2002) within the 24 hours admitted, and 6 days, 13 days after the operation respectively. Patients also received the blood check for red protein (Hb), and Lym (LY%), count of lymphocytes (LY) and albumin (ALB) in the next day of admission, the 1st day, 6th days and 13th days after the operation. SPSS 17.0 software was used for data entry and statistical analysis, χ2 test was used for comparison of the nutrition risk incidence in different points in time, P<0.05 is considered the statistically significant. Results The incidence of peri-operative nutritional risk was up to 87.88%（116/132）in the 6th postoperative day. To compare indicators of nutrition-related testing at different points, the 6th postoperative day, Hb((106.27±16.74) g/L) and ALB((31.36±3.84) g/L) measuring values are lower than any other time point; the Hb measurement was (130.79±16.67) g/L, (113.88±15.57) g/L, (113.38±18.08) g/L; ALB measurement was (38.74±3.90) g/L, (31.47±3.55) g/L and (34.82±3.68) g/L respectively in the 1st day after hospitalization, 1st and 13th postoperative day. Hb and ALB measurements in the 6th postoperative day was statistically significant different in comparison with other point in time, (χ2 values is 60.151, 63.951 respectively, P both are <0.001).In 1st postoperative day, the LY% measurement was (9.83±4.84)% and LY was (1.26±0.79)×109/L, lower than any other point in time. the LY% measurement was (23.59±8.37)% (18.69±5.97)% (21.50±6.78)% and LY measurement was （1.62±0.56）×109/L，（1.39±0.60）×109/L，（1.59±0.61）×109/L respectively in the next day of hospitalization, the 6th and 13th postoperative day. LY% value in the 1st postoperative day was statistically different with other time points (χ2 values are: 52.370, 27.662 respectively,P both are <0.001). Conclusion The perioperative patients of spinal tuberculosis have high nutritional risk. Patients have poor nutritional status within 1 week after surgery, therefore we should focus on nutritional interventions in order to promote recovery.
      Effect of team working health education for patients with thoracolumber vertebra tuberculosis operation
      BI Na, MA Yuan-zheng, YU Mei, ZHANG Yan-hui, YU Xing-yan, CHEN Jia-yi
      Chinese Journal of Antituberculosis. 2015, 37(3):  280-284.  doi:10.3969/j.issn.1000-6621.2015.03.012
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      Objective To evaluate the effect of team working health education on improving the awareness of patients with thoracolumber vertebra tuberculosis operation. Methods A total of 100 patient with thoracolumber vertebra tuberculosis operation from January to October 2014 in the Department of Orthopedics in the 309th Hospital of PLA were randomly selected. The patients treated from January to May were in the control group, and from June to October were in the experimental group. The team working health education was conducted from June. The primary nurse developed the health education plan, the group leader organized the group education, and the head nurse organized the health education ward round. The scores of patients’ awareness, satisfaction on the nursing, and the accuracy of nursing planning of health education in the two groups were observed and compared by t test. P<0.05 was considered statistically significant. Results The scores of patients’ awareness were (18.21±1.26) and (15.26±1.01), of satisfaction were (96.68±7.62) and (85.88±8.91), and the accuracy of nursing planning were (28.16±6.27) and (23.14±5.13) in the two groups, and those of the experimental group were all significantly higher than the control group (t=12.92, 6.51 and 4.38, P＜0.01). Conclusion The team working health education can improve the nursing competency of health education, and promote the satisfaction of nursing and patients awareness as well.
      Study on raising awareness rate of tuberculosis knowledge in rural areas by village doctors
      WU Bo，ZHANG Shun，YU Ya，HUANG Li，ZHANG Wen
      Chinese Journal of Antituberculosis. 2015, 37(3):  285-290.  doi:10.3969/j.issn.1000-6621.2015.03.013
      Abstract ( 1541 )   PDF (925KB) ( 513 )   Save
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      Objective To publicize the tuberculosis prevention knowledge through the one to one mode of health education to the residents of rural areas by village doctors, and evaluate the model’s role in improving the awareness rate of tuberculosis knowledge. Methods According to economic development level, physiographic condition and population feature, we selected Kai county as our research site. Through stratified cluster sampling method, we selected one village that had representative traffic and economic condition. There were 310 residents selected with random sampling method. At first, the selected residents had been surveyed with questionnaire in the baseline investigation for awareness rate of tuberculosis. The questionnaire includes general condition and core information of tuberculosis. The information comes from core awareness information of tuberculosis (2010 edition) in the health promotion manual of China tuberculosis control program. In the baseline investigation, we handed out 310 questionnaires and all were returned and valid. Then the village doctors carried out one to one mode of health education in the two villages. After 6 months, we carried out cross-sectional investigation again to evaluate the effect. This time, we again handed out 310 questionnaires and all were returned and valid. We used SPSS 19.0 to analyze awareness rate of tuberculosis. We used Chi-square test, and P<0.01 was considered statistically significant.  Results The general awareness rate of TB knowledge was 30.6%(855/2790) in the baseline investigation. After the one to one mode health promotion of 6 months, this rate increased to 77.8%(2170/2790) (χ2=1248.4，P<0.01). The awareness rate of information “cough and expectoration for more than 2 weeks should be suspected of TB disease” has been increased to 92.9%(288/310).The awareness rate of information “covering nose and mouth when coughing and sneezing, spiting will reduce the spread of tuberculosis” has been increased from 40.3%(125/310) to 89.7%(278/310) (χ2=166.0，P<0.01). The awareness rate of information “wash your hands frequently, ventilation and physical fitness can be effective in preventing pulmonary tuberculosis” has been increased  from 25.2%(78/310) to 81.9%(254/310)（χ2=200.9，P<0.01）. The proportion of people “getting knolwedge from medical personnel” has increased from 26.1%(81/310) to 42.9%(133/310) (χ2=19.3,P<0.01).  Conclusion The one to one mode of health education and promotion by village doctors has been proved effectively in raising the awareness rate of tuberculosis in rural areas.
      Comparative study between the traditional culture method and PCR-fluorescent probe method in the identification of mycobacterium species
      ZHANG Jie*, XING Qing, WANG Su-min, YI Jun-li, YANG Xin-yu, DING Bei-chuan, SU Jian-rong
      Chinese Journal of Antituberculosis. 2015, 37(3):  291-294.  doi:10.3969/j.issn.1000-6621.2015.03.014
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      Objective To compare the traditional culture method with PCR-fluorescence probe method for the identification of mycobacteria.  Methods One thousand five hundred and fifty two mycobacterial strains from clinical isolates were tested by PNB-TCH growth test and PCR-fluorescent probe method, in which the strains with different testing results were confirmed by 16S rRNA gene sequencing method.  Results Between two methods, the coincidence rate of non-tuberculosis mycobacteria (NTM) was 75.4% (46/61), the coincidence rate of Mycobacterium tuberculosis complex (MTBC) was 99.0% (1491/1506), and the overall coincidence rate was 99.0% (1537/1552). 15 strains with different testing results were sequenced with 16S rRNA gene, in which 14 were consistent with the results of PCR-probe method, and 1 was isolated and cultured, then confirmed with mixed bacteria of Mycobacterium tuberculosis and Mycobacterium Gordon. The sensitivity of PNB culture for NTM was 21.7% (13/60), and the PNB-resistant rate of MTBC was 0.1%（1/1492）. Of 13 PNB-sensitive NTM stains, 10 (76.9%) were Mycobacterium kansasii.  Conclusion The identification of part NTM isolates was misjudged using the PNB-TCH growth tests, while the PCR-fluorescent probe method for the identification of MTBC and NTM strains had higher accuracy.
      Study on the therapeutic effect with recombinant human IFN-γ on multidrug-resistant Mycobacterium tuberculosis infected mice
      HOU Jiang-hou*, LI Qi, ZHANG Ling-xia, WANG Zhong-yuan, SUN Wei-guo, ZHAO Wei-jie, CAO Min
      Chinese Journal of Antituberculosis. 2015, 37(3):  295-299.  doi:10.3969/j.issn.1000-6621.2015.03.015
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      Objective To study the therapeutic effect and immunological mechanism of recombinant human interferon γ (rh-IFN-γ) in treating the mice with multidrug-resistant tuberculosis (MDR-TB). Methods Seventy-two adult male Balb/c mice were infected with multidrug-resistant Mycobacterium tuberculosis via aerosol. Four mice were sacrificed at second day after infection to determine the colony forming units (CFUs) implanted in the lungs. Four mice were sacrificed at 21- day post infection (0 week of treatment). The remaining 64 mice were randomly divided into control group，rh-IFN-γ group，moxifloxacin group and combination therapy group (moxifloxacin+rh-IFN-γ)，16 mice in each group，and started to give medicine treatment at 0 week of treatment．Four mice per group were sacrificed at 4-, 8-, 16- and 20- weeks of treatment, to observe the mass index and live bacteria counting (CFUs) of lung and spleen at each time-point，and to detect the levels of IFN-γ and IL-10 in sera at 8 weeks of treatment．Comparison between the two groups used t test．Comparison among groups were tested by One-Way analysis of variance (ANOVA)，comparison in pairs within group used SNK method and Games-Howell method.  Results Lung and spleen mass index：the lung mass index of moxifloxacin group （5.99±0.72）at 8 weeks were significantly lower than that of control group（8.01±0.91）（F=6.28，P<0.01）．The spleen mass index of moxifloxacin group（2.87±0.15） at 8 weeks were significantly lower than that of control group （3.87±0.41）（F=8.37，P<0.01）． Lung and spleen CFUs： the lung CFUs of moxifloxacin group ［(4.37±0.20)lg/ml］ and combination therapy group ［(4.35±0.18)lg/ml］ at 4 weeks respectively were significantly lower than that of control group ［(5.30±0.21)lg/ml］ and rh-IFN-γ group ［(5.29±0.13)lg/ml］（F=35.55，P<0.01），the lung CFUs of moxifloxacin group ［(2.86±0.29)lg/ml］ and combination therapy group ［(2.63±0.08)lg/ml］ at 8 weeks respectively were significantly lower than that of control group ［(5.00±0.23)lg/ml］ and rh-IFN-γ group ［(4.82±0.55)lg/ml］（F=56.83，P<0.01），and were sterile from 16 weeks (without the growth of Mycobacterium tuberculosis)．Spleen CFUs of rh-IFN-γ group ［(3.21±0.40)lg/ml］ at 20 weeks were significantly lower than that of control group ［(4.31±0.06)lg/ml］（t=5.45，P<0.01）．Spleen tissue of moxifloxacin group and combination therapy group were sterile from 4 weeks．IFN-γ and IL-10 levels in the sera at 8 weeks：the serum IFN-γ levels of rh-IFN-γ group ［（3.40±0.64）ng/L］, moxifloxacin group ［（1.32±0.53）ng/L］ and combination therapy ［（0.47±0.44）ng/L］ were significantly lower than that of control group ［（10.34±2.09）ng/L］（F=55.973，P<0.01）， the serum IFN-γ levels of moxifloxacin group and combination therapy group respectively were obviously lower than that of rh-IFN-γ group（F=55.973，P<0.01）; the serum IL-10 levels had no significant difference among control group ［（6.68±1.30）ng/L］，rh-IFN-γ group ［（9.76±3.97）ng/L］，moxifloxacin group ［（8.74±4.48）ng/L］ and combination therapy group ［（21.34±17.58）ng/L］（F=2.013，P>0.05）. ConclusionRh-IFN-γ can reduce the number of Mycobacterium tuberculosis in splenic tissue and lowered serum IFN-γ levels of MDR-TB mice，but had no significant effect on reducing the number of Mycobacterium tuberculosis and the inflammation in lung tissue of MDR-TB mice．Rh-IFN-γ in combination with moxifloxacin had also no auxiliary role on the treatment of MDR-TB, and on reducing bacteria loads and inflammation of organs in mice.
      Species identification with multilocus sequence analysis and drug-sensitivity test in Mycobacterium massiliense clinical isolates
      WEI Jian-hao*, GUO Qian, LI Gui-lian, LIU Hai-can, LI Ma-chao, WU Yi-mou, LOU Yong-liang, LV Jian-xin, WAN Kang-lin
      Chinese Journal of Antituberculosis. 2015, 37(3):  300-306.  doi:10.3969/j.issn.1000-6621.2015.03.016
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      Objective To confirm the species of the clinical isolates suspected Mycobacterium massiliense (M. massiliense) which could not be identified by the single gene comparison, and test their drug-sensitivity spectrum to provide the basis of clinical diagnosis and treatment.  Methods In 2013，we collected 47 clinical samples of the patients suspected with non-tuberculous Mycobacteria (NTM) infection in Tuberculosis Laboratory of National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention. The Mycobacteria isolates were determined with the media containing p-nitrobenzoic acid (PNB) and 2-thiophene carboxy-lic acid hydrazide (TCH) respectively and multilocus PCR. Five house-keeping genes (16S rRNA, hsp65, rpoB, sodaand recA) were analyzed by DNA sequencing, and compared by Basic Local Alignment Search Tool (BLAST) to identifying the species of NTM, in which the species of 6 M. massiliense isolates were confirmed by means of multilocus sequence analysis (MLSA). The drug-sensitivities of M. massiliense isolates to 36 antibiotics were tested with the minimal inhibitory concentrations (MICs) by Microplate AlamarBlue Assay(MABA).  Results Of 47 clinical samples from the patients suspected with NTM infection, 34 NTM strains were isolated, in which 6 strains could not be identified by DNA sequencing and BLAST using the single gene sequence comparison with five house-keeping genes. These strains were confirmed as M. massiliense by MLSA with a Neighbor-joining tree. The drug sensitive spectrum to 36 antibiotics showed that M. massiliense isolates were sensitive to Amikacin (16 μg/ml or 32 μg/ml), resistant to 12 kinds of anti-tuberculosis drugs, rifampin, isoniazid, ethambutol, ciprofloxacin, ethionamide, capreomycin, para-aminosalicylic acid, ofloxacin, kanamycin, cycloserine, meropenem, and minocycline; and extremely insensitive to isoniazid aminosalicylate, cefoperazone and thioacetazone.  Conclusion The MLSA method is effective in identification of M. massiliense strain. M. massiliense strains had a higher degree of drug resistance.
      The development of the spinal tuberculosis with neurological deficit
      TANG Kai，DONG Wei-jie，QIN Shi-bing
      Chinese Journal of Antituberculosis. 2015, 37(3):  307-311.  doi:10.3969/j.issn.1000-6621.2015.03.017
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      Neurological deficit is one of the most serious complications of the spinal tuberculosis, which is divided into two types: active type and healed type. The main cause of active neurological deficit are mechanical compression on spinal cord by epidural leision, kyphosis or intervertebral joint dislocation developed from spinal bone destruction, while the cause of healed one are serious kyphosis, the compression of spinal cord by hyperplasia of transverse ridge of bone anterior or fibrous scar left in spinal canal. Good neural recovery happened in patients whose MRI shows normal or nearly normal morphology of spinal cord, with inflammatory edema and no obvious atrophy. While poor neural recovery appears in patients with abnormal morphology of spinal cord (atrophy, myelomalacia and cavity).For the active type patients, drug treatment combined with operation according to the mechanism of neural dysfunction and disease progression characteristics and selecting suitable operation procedures according to the imaging characteristics is conducive to the early recovery of nerve function. While for the healed type patients, the operation is difficulty, bad prognosis on nerve functional recovery. Prevention of severe kyphotic is the key to treatment.
      The analytic performance studies of Mycobacterium tuberculosis Complex DNA detection reagents
      LIU Rong-zhi
      Chinese Journal of Antituberculosis. 2015, 37(3):  312-314.  doi:10.3969/j.issn.1000-6621.2015.03.018
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      The material of the analytic performance studies of Mycobacterium tuberculosis Complex DNA detection reagents is an important technical document of the application materials for reagent registration. The main aim of this paper is to summarize the main projects and related technical details of analytic performance evaluation studies in order to guide manufactures to conduct research and development of reagents scientifically and rationally.

Monthly, Established in Novembar 1934
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