The Holistic Approach Of Debridement And Bone Grafting With Internal Fixation Via Axillary Midline Through Anocelia Approach For Treatment Of Upper And Middle Thoracic Tuberculosis

Objective:To investigate the clinical research of debridement and bone grafting with internal fixation via axillary midline through anocelia approach for treatment of upper and middle thoracic tuberculosis.Methods:1.12patients with upper and middle thoracic tuberculosis underwent one-stage debridement and bone grafting with internal fixation via axillary midline through chest. There are8men and4women aging35to77year-old, with the average age of44.6years old. Pathological spines change from T3to T6. All patients had various degree of chest pain in their back and chest numbness below, with.tuberculosis poisoning symptoms such as loss of weight and afternoon fever. Ten of the patients have different degrees of spinal nerve compression symptoms. Chest and back pain was classify by visual analogue scale (VAS), and the average point is5.67±1.23, belong to moderate pain. The kyphosis Cobb’s angle ranged from14.19-32.23°before operation, with the average angle of24.09±5.08°. The patients were followed up for3to24months after surgery.2. Using SPSS19.0statistical software to deal with the collected data. When compared the difference, set the statistically significant at P<0.05, and analyze the healing effect of treating thoracic spinal tuberculosis in this surgical approach.Results:1. All patients stood operation well. The operation time was100-170minutes, with the average time of138±19minutes, and the bleeding during operation was500-1000ml, with the average volume of667±156ml. The postoperative drainage was100-400ml, with the average volume of216ml±87ml. There was no complication after operation.2. When came back for a check in1month after surgery, the kyphosis Cobb’s angle ranged from12.67°±to30.37°, with the average angle of22.49°±5.13°. The preoperative and postoperative Cobb’s Angle via the paired T test, the D-value via test of normality, we can have W=0.913, P=0.232>0.1. And D-value followed Gaussian distributions,(t=15.260, P=0.000<0.05). We can consider that the preoperative and postoperative Cobb’s Angle had statistically difference. The average correct was1.60°±0.36°.3. When came back for a check in1month after surgery, visual analogue scale (VAS) have different degrees of improvement, with an average points of3.25±0.97. The preoperative and postoperative VAS via the paired T test, the D-value via test of normality, we can have W=0.920, P=0.284>0.1. And D-value followed Gaussian distributions,(t=10.085, P=0.000<0.05). We can consider that the preoperative and postoperative VAS had statistically difference. The average point of improvement was3.75±1.29. 4. During the last follow-up of those10cases of patients with neurological symptoms,2cases of D recovered to E and the rest8cases recovered to D. Via Fisher’s exact test in chi-square test, we had P=0.006<0.05. We can consider that the preoperative and postoperative Frankel classification of neurological function had statistically difference.5. During the follow-up period, all cases healed without recurrence. There was no breakage of nails or fall of the internal fixation. Spinal bone fusion occurred after3to6months(median time,5months) after bone graft in all patients.Conclusion:The approach via axillary midline through anocelia can achieve the goal of clearing lesion, decompression bone graft fixation for treatment of upper and middle thoracic spinal tuberculosis, and obtain good curative effect. Because of the special anatomic structure of upper thoracic, he approach via axillary midline through anocelia has certain advantage when treating upper and middle thoracic spinal tuberculosis.