| Objective:To observe the clinical efficacy of percutaneous spinal endoscopic debridement and continuous chemotherapy for spinal tuberculosis.Methods:The clinical data of 20 patients with spinal tuberculosis who were followed up by the same team in our hospital from July 2016 to August 2018 were retrospectively analyzed.All patients underwent percutaneous spinal endoscopic debridement and continuous chemotherapy..There are 11 males and 9 females,aged 25-83 years,with an average age of(58.0 17.6)years.All patients were evaluated by Visual analogue scale(VAS)for pre-and post-operative 1 month and terminal follow-up.The Oswestry disability index(ODI)was used to preoperatively.The functional status at the first month and the end of follow-up was scored,and the Erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were evaluated before and after surgery.At 3,4,and 12 weeks,the inflammatory control was measured.The serum albumin(Albumin,ALB)and hemoglobin(Hb)were measured to evaluate the nutritional status of patients before and after 1,2,3,4,and 12 weeks.Observe the patient’s drainage during hospitalization,regular follow-up after surgery,follow-up imaging results and understand the complications.Results:All patients underwent surgery under local anesthesia.There was a small amount of intraoperative blood loss,no blood transfusion,no nerve or vascular injury occurred during operation,and spinal tuberculosis was confirmed by pathology.The patient underwent local chemotherapy for 31-65 days with an average of 40.3 days.Most patients can take out or use a syringe to extract turbid liquid in a range of30-50 ml per day within a week after surgery,and then gradually reduce the amount of extraction,cumulative withdrawal of all patients during hospitalization(calculated from the third day after surgery)and pus The amount ranges from 200 to 2000 ml.Among them,one female patient died of heart failure due to uremia and died within 4months after surgery.Therefore,no follow-up was obtained in the later stage,and the remaining patients were followed up.All patients were followed up for 8 to 33 months,with an average of 16.35 months.At the last follow-up,19 patients were cured,including 3 cases of multi-segment spinal tuberculosis without surgical segment,and also obtained clinical cure.No abnormalities in wound healing,local No sinus was seen,and the discomfort of the lower back and lower limbs was significantly improved compared with preoperative.Five patients with Frankel grade D before neurological damage were recovered,and all of them recovered to Frankel grade E.There was no recurrence after discontinuation.MRI showed that the preoperative lesions of the vertebral body and vertebral body fusion were restored to normal.Patients who underwent conventional surgery before minimally invasive surgery did not have loose or broken internal fixation.Healing patients can take care of themselves,can engage in light and physical activity,patients with weight loss before surgery have increased body weight,food intake returned to normal,mental state has improved,no fever,night sweats and other phenomena.The preoperative VAS score of this group was(6.1±0.9)points,(2.9±0.8)points(p<0.01)in the first month and(1.1±0.7)points(p<0.01)in the final follow-up period..The preoperative Oswestry dysfunction index was(62.67±10.73)points,the first month after surgery was(24.42±5.44)points(p<0.01),and the final follow-up period was(10.39±3.40)points(p<0.01).The preoperative CRP of this group was(53.1±19.9)mm/L.The majority of patients in the first week after operation were higher than the preoperative level,and the increase was(55.1±17.0)mm/L,but the difference was not statistically significant.(p>0.05),the second,third,fourth,and fourth weeks after surgery were significantly lower than before surgery,respectively(38.4±13.8)mm/L,(25.4±9.6)mm/L,(13.7±3.7)mm./L,(5.5 ± 1.5)mm / L(p < 0.05),returned to normal at the12 th week after surgery.There was no significant difference in ESR between the first,second,third,and fourth weeks after surgery,but returned to normal at 12 weeks after surgery(p<0.05).The preoperative ALB was(31.44±2.70)g/L,and the first and second weeks after surgery were slightly higher than those before surgery,but the difference was not statistically significant(p>0.05).Postoperative 3,4,12 The weekly elevation was significantly higher than that before surgery(38.97±2.36)g/L,(40.32±2.83)g/L,and(42.21±2.25)g/L(p<0.05).The preoperative HB of this group was(100.10±6.02)g/L.There was no significant change in the first,second and third weeks after operation.There was no significant difference(p>0.05),and the 4th and12 th week after operation.Compared with preoperative,it increased to(104.70±7.26)g/L and(114.40±6.98)g/L(p<0.05).Conclusion:Percutaneous spinal endoscopic debridement and drainage of the local continuous chemotherapy for the treatment of spinal tuberculosis with high safety and small trauma,can remove tuberculosis during surgery,and can retain tissue specimens for pathological diagnosis and culture,through local indwelling Pipeline drainage and administration to improve local drug concentration,and can obtain good curative effect,is a suitable treatment for patients with poor systemic basis,advanced age,and can not tolerate traditional surgery and kyphosis. |
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