| Purpose : To evaluate the efficacy of different fixation methods for thoracolumbar tuberculosis.Methods : The clinical data of 93 cases of thoracolumbar tuberculosis admitted from December 2005 to September 2010 were retrospectively reviewed and all cases were treated by focus clearance, bone graft fusion and internal fixation. All cases were divided into three groups according to different surgical procedures: group A of 51 patients: anterior focus clearance with one session anterior screw-rod internal fixation: group B of 23 patients: posterior focus elimination and bone grafting with one session pedicle screw fixation,: group C of 19 patients: anterior focus clearance and bone graft fusion with one session posterior internal fixation,. The blood loss in operation, operation time, graft fusion, postop neurological recovery, postop chest and back pain and postop activities were analyzed and compared among three groups to evaluate the therapeutic effects of 3 different surgery methods.Result : All patients were followed up for 6～60 months and the average time is 19 months. In group A, the average operation time was 207.2min with average blood loss at 959.0ml; in group B, the average operation time was 272.0min with average blood loss at 1239.1ml; in group C, the average operation time was 254.2min with average blood loss at 820.5ml.According to Franke1 neural function classification, there were 18 patients had neurological deficits in group A before surgery, and 9 and 10 patients in group B and C respectively. Within 6 months after operation, in Group A, 14 cases recovered from Class D to Class E, 2 of 3 cases from Class C to Class E, the other one to Class D, and one case from Class B to Class E. In Group B, 5 cases recovered from Class D to Class E, 2 cases from Class C to Class E, 2 cases from Class B to Class D. In group C, 6 cases recovered from Class D to Class E, 2 of 3 cases from Class C to Class E, the other one to Class D, and one case from Class B to Class E. The cure rate of each group after operation was 83.3%, 77.8%, and 80% respectively. All the patients had bony fusion at the end of followed-up. The fusion time of group A was 3 to 13 months with an average of 7.2 months; the fusion time of group B was 4 to 10 months with an average of 6.6 months, the fusion time of group C was 3 to 12 months with an average of 7.0 months. For the evaluation of postoperative chest and back pain and postop activities, group A had 35 excellent, 13 good and 3 fair with a fineness rate of 94.1%. Group B had 16 excellent, 5 good and 2 fair with a fineness rate of 91.3%. Group C had 15 excellent, 3 good and 1 fair with a fineness rate of 94.7%. There were 18 patients had kyphosis in group A before surgery, and 10 and 7 patients in group B and C respectively. The preoperative average angle of kyphosis of each group was 27.4°, 34.2°, 34.7°,Within 1 week after operation, the average angle correction value of each group was 12.4°, 20.8°, 21.7°.In group A, surgical incisions of all cases had stage I healing; with three recurrent cases and one case of femoral nerve paralysis after surgery which recovered one year after. In group B, one case had sinus tract before surgery which was cured 9 months after surgery. Other patients in group B had surgical incision stage I healing. One case in group B had postop bilateral psoas abscess and was cured after CT guided psoas abscess aspiration and lavage. All surgical incisions in group C had stage I healing. There were two recurrent cases in group C were cured after receiving a secondary operation.Conclusion : No matter which surgical procedure was chose, the surgical purposes are always the same, i.e. to effectively remove disease and to reconstruct spinal stability. Anyway, the choice of any surgical procedures should always base on patients'own conditions... |
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