Comparative Study On Therapeutic Effect Of Subscapularis Transthoracic And Posterolateral Approach For Upper Thoracic Tuberculosis

Objective: To compare the therapeutic effect on subscapularis transthoracic approachand posterolateral approach debridement, bony fusion and internal fixation for theupper thoracic tuberculosis.Methods: Retrospectively analyze43cases of upper thoracic tuberculosis fromJanuary2002-February2014in our hospital who underwent subscapularistransthoracic(group A) and posterolateral(group B) approach debridement, bonyfusion and internal fixation. In43cases, there was21cases in group A,22cases ingroup B. Compare the operative time, blood loss, hospital stay, the cure rate,incidence of postoperative complications, postoperative Cobb angle correction,postoperative neurological recovery of the two groups of patients.Results: The mean operative time of group A was (192±10) min, and the meanoperative time of group B was (142±13) min; By t test, p=0.042＜0.05，the differenceof the time of the two group was statistically significant, namely the time of group Awas longer than that of group B. The average blood loss of group A was (1150±235)ml, and the average blood loss of group B (1142±242) ml, by t test, p>0.05, thedifference was not statistically significant. The average hospital stay of group A was(20.6±1.2) d, and the average hospital stay of group B was (21.2±1.4) d; by t test,p>0.05, the difference of the two hospital stay was not statistically significant.The cure rate of group A is95.24%, and the cure rate in group B is90.91%. By χ2test,there was no significant difference between them. The Cobb angle in group A wascorrected from preoperative(36.5±4.8)°to postoperative (24.8±5.6)°, and thecorrection rate was30.9%. In group B the Cobb angle was corrected frompreoperative (34.5±5.2)°to postoperative (10.2±2.6)°, and the correction rate was68.5%. By χ2test, there was statistical significance between the two rate(p=0.035<0.05).Preoperative and postoperative Cobb angle between the two groups,by t test, P=0.043<0.05, had significant differences. Namely the ability to correctthe kyphosis of posterolateral approach was better than that of subscapularistransthoracic approach. As two cases with postoperative shoulder dysfunction ingroup A, two cases of lung infection, the incidence of postoperative complicationswas19.04%. As3cases with cerebrospinal fluid leakage and one case of lunginfection in group B, the incidence of postoperative complications was18.18%. By χ2test, p>0.05, the difference of the two rate was not statistically significant. Twogroups of patients had improved neurological damage after surgery. The difference ofFrankel neurological function scores of the two groups, by t test, p>0.05, was notstatistically significant.Conclusions: Subscapularis transthoracic approach and posterolateral approachdebridement, bony fusion and internal fixation for the upper thoracic tuberculosis canget the same clinical effect, but the ability to correct kyphosis and operative time ofposterolateral approach was better than that of subscapularis transthoracic approach.