关键词: 结核, 脊柱, 颗粒物, 治疗, 临床研究性

Abstract:

Objective: To assess the clinical outcomes of single-stage posterior debridement, intervertebral autogenous morselized bone grafting, and internal fixation for the treatment of thoracolumbar tuberculosis. Methods: This retrospective analysis encompassed 31 patients with thoracolumbar tuberculosis treated at the Orthopedic Department of Xi’an Chest Hospital from January 2020 to June 2022, all undergoing single-stage posterior lesion clearance, intervertebral autogenous morselized bone grafting, and internal fixation. Surgical metrics analyzed included duration, blood loss, complications, and postoperative improvements in Visual Analogue Scale (VAS) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), spinal cord function (Frankel classification), spinal curvature (Cobb angle), and bone graft fusion. Results: The study followed up 31 patients for a period ranging from 18 to 36 months, averaging (24.0±8.5) months. There were no instances of nerve or spinal cord injuries during surgeries, nor were there cases of postoperative wound infections. Surgical metrics revealed an average duration of (190.6±64.4) minutes and blood loss of (442.5±114.6) ml. Notably, at 3 months postoperatively, significant improvements were observed with the VAS scores decreasing from 5.5±1.9 to 2.2±0.7, ESR from (49.3±18.1) mm/1 h to (11.9±6.6) mm/1 h, and CRP levels from (34.1±16.7) mg/L to (7.9±5.5) mg/L, all demonstrating statistically significant reductions (t-values of 10.554, 11.683, and 9.826, respectively; P<0.001). Fusion was achieved after interbody bone grafting surgery. At the last follow-up, the Cobb angle was (9.6±3.3)°, and compared with preoperative ((18.5±5.8)°), the difference was statistically significant (t=11.527, P<0.001). The last follow-up Frankel neurological function grading was D grade in 2 cases and E in 29 cases. Conclusion: Single-stage posterior lesion clearance combined with intervertebral autogenous morselized bone grafting and internal fixation proves to be a safe and efficacious strategy for thoracolumbar tuberculosis patients fitting surgical criteria. The procedure demonstrates definitive therapeutic outcomes.

Key words: Tuberculosis, spinal, Particulate matter, Therapies, investigational