The Research Of The Surgery Time And The Clinical Efficacy Of Activities Thoracic Tuberculosis With Paraplegia

Objective:It is to research the relationship between the clinical efficacy of activities thoracic tuberculosis with paraplegia and the timing of surgery by analysing of different timing of surgery on the postoperative pain, the recovery of spinal cord injury, the changes of spinal bone structural, the postoperative complications in the process of treatment of thoracic tuberculosis with paraplegia patients.Methods:A retrospective analysis were carried out to choose 28 patients with thoracic spinal tuberculosis of activity type with paraplegia according to the standard from January 2012 to January 2014 in our hospital. In accordance with the length of the time from admission to surgery, the patients were divided into two groups. The group Iof 12 patients were operated after giving Anti—tuberculosis treatment(HRZES) less than 3 days(average 2.1days),and the group II of 16 patients underwent surgery after giving Anti—tuberculosis treatment(HRZE) 2 to 6 weeks,when the ESR and CRP had sharply decreased or be normal. Analyse the degree of pain, the morbidity of complications, the spinal cord function index, the spinal disability index and the graded damaged spinal nerves of the two groups of patients on the time before surgery, after surgery of two weeks and the last follow-up.Results:All patients were no aggravating paraplegia,and the recovery of nerve function iefaster in 3 months after surgery than other time. All patients were followed up for 14-36months(average 18.5 months).7 patients of Group I and 2 patients of Group II had postoperative complications. All the other patients heald with no recurrence. Both the complications of 2 Groups are given statistical test, and the difference was statistically significant(P <0.05), which can be considered that early surgery group(Group I) undergoes more complications.The Cobb angle, MPQ, ODI and ASIA grade of preoperative,postoperative and the Last follow-up(within the group) was significantly(P <0.05), which show the surgery is useful. The Cobb angle, MPQ, ODI and ASIA grade of the two groups show no significant difference(P > 0.05), the timing of surgery have no clear impact on the recovery of nerve function.Conclusions:The activities thoracic tuberculosis with paraplegia should be early surgery in principle with standardized anti-TB drugs.The nerve function recovery of early surgery group(Group I) is better, but the complications is more, which should be closely nursed in condition and deal with timely.The pathological mechanism of thoracic spinal tuberculosis of activity type with paraplegia differs from that of acute spinal cord injury. The Solution of active TB disease with paraplegia of early peforming surgery after the complications treated timely can effectively relieve spinal cord compression and promote paraplegia recovery. The recovery of neurological function is well,which is needless of emergency surgery. The time window for surgery of thoracic spinal tuberculosis of activity type with paraplegia needs further study.