| Background Surgical treatment for thoracolumbar tuberculosis clinic in recent years,great progress has,since the thoracolumbar part of complex anatomy and disease vary,clinicians inconsistent surgical method of choice,the main surgical methods are: simple anterior,posterior and simple before and after Road joint surgery.More and more reports isolated posterior surgical treatment of thoracolumbar tuberculosis cases,and success.Therefore,this study analyzed and compared the efficacy of a posterior indicators and a combined anterior and explore thoracolumbar tuberculosis most appropriate treatment in order to improve understanding and thoracolumbar tuberculosis diagnosis and treatment.Objective To compare clinical effect of one-stage posterior and one-stage combined anterior-posterior debridement,bone graft and instrumentation for thoracolumbar tuberculosis,in order to improve the level of understanding of thoracolumbar tuberculosis diagnosis and treatment,find the most reasonable and effective treatment.Methods Organize statistical clinical data,from December 2012 to December 2014,the clinical data of 71 patients with spinal tuberculosis were reviewed retrospectively,which 20 cases in posterior surgery group(A group)were treated with one-stage posterior debridement,bone graft and instrumentation.51 cases in combined anterior-posterior group(group B)were operated with the posterior pedicle screw fixation and anterior debridement,bone graft and instrumentation.Observe and evaluate the patient's operation time,blood loss,hospital stay and ASIA neurological function before and after surgery,VAS score,Cobb angle,ESR change,C reactive protein,bone graft fusion in both two groups and make statistical analysis about these data..Results 1.Baseline parameters were similar between groups,there was no significant difference(P> 0.05).2.Surgery in both groups was successfully completed,A group of patients in the aspects of operative time,with an average of(205.2±55.4)minutes;blood loss(490.0±210.0ml)ml was significantly reduced(P <0.05)compared with group B(254.9±69.6)min?(597.6±303.5)ml.Comparison of surgery-related indicators of the two groups of patients were significantly differences(P<0.05).3.After 6-24 months follow-up with an average of 18 ± 2.4 months,Group A VAS score before and after operation(5.0±1.2),Cobb Angle of preoperative(24.7±5.1)°,after operation 6 weeks(14.7±2.7)°,the last follow-up(13.8±2.5)°,the ESR value of before operation(45.9±26.2)mm/h,after operation 6 weeks(19.6±5.1)mm/h,three months after surgery(12.2±4.2)mm/h,CRP values of before operation(39.6±6.2 mg/L),after operation 6 weeks(8.8±3.1mg/L),three months after surgery(3.6±1.3 mg/L)and group B before and after surgery VAS score(5.0±1.1mm),Cobb Angle(24.5±6.1,14.9±2.9,13.6±3.0)°,the ESR value(43.4±22.0,18.2±3.6,11.4±3.5)mm/h,CRP(36.7±7.9,9.0±2.9,4.1±1.4 mm)mg/L were no significant difference(P > 0.05),but Group B ASIA neurological function was a remarkable difference compared with group A(P<0.05).4.At the last follow-up,no tuberculosis recurrence happened.Without internal fixation failure and related complications,all cases had evidence of solid bony fusion.Comparison of surgery-related complications of the two groups of patients were significantly differences(P>0.05).Conclusions 1.The show combined anterior bone graft treatment of thoracic and lumbar tuberculosis precise,reliable,good recovery after the disease,before and after a satisfactory inspection data according to the study.2.A posterior surgery with less trauma advantages,but not as good as a removal of the lesion anterior thorough potential risk of recurrence,needs strict control of surgical indications. |
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