| BackgroundTuberculosis is an ancient disease that seriously endangers human life and health.Tuberculosis of the spine in bone joint tuberculosis is most common,it destroys intervertebral disc and vertebral body,bring about vertebral kyphosis deformity,bring about paraplegia even.At present,surgical treatment is very important.Combined anterior and posterior approach surgery has been highly recommended for a long time,but it has large trauma and high risk.Recently,more and more scholars advocated simple posterior surgery and achieved good results.Structural reconstruction is required for most of the bone defects associated with spinal tuberculosis lesions after clearance.Currently,there are a wide variety of bone graft materials available,and there is no uniform standard for their selection.The author used autogenous ribs and ilium titanium cage for bone graft to reconstruct the spinal bone structure,and compared their clinical safety and efficacy.ObjectTo compare the clinical efficacy of one-stage posterior focus on debridement with autologous rib bone graft fusion and iliac titanium mesh bone graft fusion in the treatment of thoracic spine tuberculosis.MethodsFrom July 2015 to August 2019,58 patients with thoracic spine tuberculosis were selected from Jiaozuo People’s Hospital and the First Affiliated Hospital of Xinxiang Medical College.The patients were divided into two groups.28 patients in group A received first-stage posterior lesions Autogenous rib clearance and bone graft fusion,30 patients in group B received one-stage posterior debridement of iliac bone and titanium mesh bone graft fusion.Operation time,intraoperative blood loss,bed time,hospital stay,bone graft fusion time,VAS before and after operation,erythrocyte sedimentation rate and C-reactive protein,Frankel grading,Cobb Angle and complications were observed in the two groups.ResultsThe patients were followed up for 12 to 54 months.All patients had bone graft fusion,and no internal fixation failed.There was no significant difference in the operation time,the postoperative bed time,the hospitalization time,erythrocyte sedimentation rate and C-reactive protein and the bone graft fusion time between the two groups(P>0.05).The intraoperative blood loss in group A was significantly lower than that in group B(P<0.05),the VAS scores of the two groups were significantly improved compared with preoperntion.The VAS scores of group A were lower than those of group B at 1 week after operation(P<0.05),and there was no statistical significance at the last follow-up(P>0.05);Frankel classification Both were significantly improved compared with preoperntion;the Cobb angle correction in group A was(6.36±6.12)°,the Cobb angle correction in group B was(6.20±5.30)°,there was no statistical significance between the two groups(P>0.05);group A The loss of Cobb angle was(2.71±1.58)°,and the loss of Cobb angle in group B was(3.53±1.48)°.The comparison between the two groups was statistically significant(P<0.05).Group A maintained Cobb better than group B Angle correction.One patient in group A had postoperative numbness in the flanks;in group B,2 patients in the iliac bone removal area had fat liquefaction(1 had infection),1 patient had subsidence of the titanium mesh,and 4 patients had pain in the iliac area.After conservative treatment,all the above patients improved significantly.ConclusionOne-stage posterior debridement autogenous rib bone graft fusion and iliac titanium mesh bone graft fusion can effectively treat thoracic tuberculosis,but the first surgical procedure can better maintain the correction of the spine Cobb angle and reduce Intraoperative bleeding,while effectively avoiding complications caused by iliac bone removal. |
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