The Curative Effect Of Different Surgical Approach To Treat Lumbar Spinal Tuberculosis And Indications

Objective:To analyse the different surgical approach for the treatment of lumber spinal tuberculosis surgeryMethods:From January2005to May2010,The Second Clinical Medical College of Shanxi Medical University were followed up for53patients with complete data of the lumbar spine tuberculosis cases, Before the surgery, all patients should be treated with the regular, enough, untied, full, indibidualized, antituberculosis therapy. Depending on the imaging evaluation criteria, All patients were divided into group A (anterior debridement and fusion of internal fixation surgery,26cases), group B (posterior debridement and fusion of internal fixation surgery,14cases), group C (The simultaneous anterior and posterior approaches and internal fixation and fusion,13cases). All patients of preoperative and postoperative were be assessed by neurological function, measurement of the Cobb angle, detected ESR of the preoperative and postoperative, operation time, blood loss, hospitalization time, comparative and analysis the neurologic classification of three groups of patients with preoperative and postoperative, Cobb angleESR, surgery time, blood loss, hospital stay differences.Result:53patients were followed up for6to41months, an average of15.6months. The preoperative patients with neurologic dysfunction of group A are11cases, the neurological function of6postoperation cases improved significantly; The preoperative patients with neurologic dysfunction of group B are7cases, the neurological function of4postoperation cases improved significantly; The preoperative patients with neurologic dysfunction of group C are6cases, the neurological function of5postoperation cases improved significantly;With analysis, The ASIA of three groups’ameliorative situation was no significant difference (P>0.05); The Cobb angle, the postoperation ESR and3months after postoperation inprovements of group A than preoperation was significantly lower (P<0.05), The Cobb angle, the postoperation ESR and3months after postoperation inprovements of group B than preoperation was significantly lower (P<0.05); The Cobb angle, the postoperation ESR and3months after postoperation inprovements of group C than preoperation was significantly lower (P<0.05); the Cobb angle,and ESR changes among three groups were significant differences (P>0.05), The difference of operation’s time, blood loss, hospitalization time among three groups was significantly (P<0.05), Among the three groups in operative time, blood loss, hospitalization time were significantly different (P<0.05);significantly different (P<0.05) between group A, group B and group C;group A and group B significant difference (P>0.05).Conclusion:Three surgical approach, including the anterior, posterior and The simultaneous anterior and posterior, good results to improve nerve function in patients with lumbar spinal tuberculosis and the correction of spinal deformity.But a single surgical approach to the way than the combined anterior surgical approach has obvious advantages in reducing the operative time, intraoperative blood loss, hospital stays. This can be achieved good clinical results. Follow a comprehensive, individualized treatment principle,taking a single surgical approach of stage Ⅰ for clearing the nidus away, fixation and fusion, reconstruction of spinal stability.