| BackgroundDue to the increase of population mobility,the increase of HIV/AIDS epidemic,the spread of drug resistant tuberculosis bacteria and so on,TB continues to spread worldwide.Tuberculosis epidemic situation in developing countries is still very serious,and there is a rising trend of tuberculosis infection.China as a developing country is still a high incidence of tuberculosis.Spinal tuberculosis is a common pulmonary tuberculosis,and thoracic and lumbar spine tuberculosis is more common in spinal tuberculosis.Spinal tuberculosis mainly damaged the anterior and middle columns of the spine,which seriously affected the stability of the lesion,so the rate of deformity and disability rate was high.In the treatment of spinal tuberculosis,the stability of the reconstruction is very important after the removal of the lesion.With the development and improvement of the internal fixation technology,the treatment of thoracic and lumbar tuberculosis by anterior approach has been recognized by most scholars,and has become a classic surgical treatment for spinal tuberculosis.With the anterior surgery for the treatment of spinal tuberculosis is widely carried out,in the correction of deformity correction and stand out the lack of maintenance.Many scholars using anterior focus clearance,bone graft fusion with internal fixation treatment of spinal tuberculosis and achieved good effect.Effectively solve the problem of deformity correction and maintenance of correction.The combination of anterior and posterior approaches has been recognized by more and more scholars.But the combination of anterior and posterior approach often requires two incisions,and the replacement of body position during the operation.Compared with the simple anterior and simple posterior approach,it takes longer operation time,more blood loss and longer stay in hospital.And simple posterior debridement,bone graft fusion and internal fixation can be a good solution to the above problems.But many scholars still have the following concerns: if the ability to completely remove the lesion,whether the disease will be introduced into the rear of the health organization,after the destruction of the health of the column can be a strong fixed spine.Guven et al.In the early surgical treatment of spinal tuberculosis with no obvious abscess,and no anterior radical debridement,the treatment of spinal tuberculosis can obtain satisfactory curative effect.Lee et al early with one stage posterior focus debridement,bone graft fusion,pedicle screw internal fixation,treatment of vertebral destruction and deformity lighter thoracic and lumbar tuberculosis cases,postoperative neurological function must have been significantly improved,kyphosis deformity was corrected well,at the time of the last follow-up correction angle only lost 4.55°.Chinese scholars also have to report posterior debridement,bone grafting fusion combined with internal fixation for the treatment of spinal tuberculosis,the curative effect were satisfactory.Pu et al.Conducted a retrospective comparative study of two different surgical treatments of thoracic and lumbar spinal tuberculosis,and found that the posterior approach can achieve the same clinical effect as the anterior approach.But because of the different factors,such as the location of the lesion,the extent of lesion and the degree of bone destruction,the spinal tuberculosis has decided the diversity and complexity of spinal tuberculosis.A comparative study of different surgical approaches for treatment of spinal tuberculosis with the same baseline level has not yet appeared,Therefore,different surgical approach to treat the same site,the same degree of spinal tuberculosis of the prospective comparison study is significant.This study included 94 patients with single segment thoracic and lumbar spine tuberculosis treated by anterior or posterior approach from April 2015 to February 2012.A comparative study of two types of operation is performed.PurposeThrough prospective study of anterior and posterior debridement,structural bone graft fusion and internal fixation of two surgical treatment of thoracic and lumbar spinal tuberculosis.To compare the general conditions of the two types of operation in the treatment of thoracic and lumbar vertebrae in a single segment of the lumbar spine,tuberculosis,clinical efficacy,and after the correction of scoliosis and maintenance.To compare the technical characteristics,advantages and disadvantages of two kinds of surgical treatment of thoracic and lumbar vertebrae tuberculosis.Material and MethodsFrom February 2012 to April 2015,a total of 100 cases of thoracic and lumbar spinal tuberculosis were included in the study group,94 patients were followed up for 94%(94/100).Separate study and analysis of single segment thoracic tuberculosis and single segment lumbar spine tuberculosis.To facilitate the discussion,the anterior group as group A,including group AT(single segment thoracic spine tuberculosis surgery group),group AL(single segment lumbar tuberculosis anterior group),patients underwent One stage anterior debridement,interbody fusion and internal fixation.Posterior surgical group as group B,including group BT(single thoracic tuberculous posterior surgical group)and group BL(single segment lumbar tuberculosis posterior surgical group),patients underwent one-stage posterior debridement,interbody fusion and internal fixation.There were 17 cases of single segment thoracic spinal tuberculosis anterior surgery group(group AT),the average age was 39.6 years old,of which 6 were male and 11 were female.Posterior surgery group(BT group)included 25 cases,average 41.4 years old,of which 12 were male and 13 were female.There were 2 cases in group AT and 3 cases in group BT with great gravity abscess.In the group AT,13 cases were combined with the convex deformity,and the average post convex angle was 26.9 degrees(16.0~40.1 degrees),there were 15 cases in the BT group,and the average post convex angle was 25.9 degrees(11.8~44.1 degrees).Two groups were associated with different degrees of neurological impairment and the group AT in 11 cases,according to the classification of ASIA(American Spinal Injury Association),1 cases with grade C,10 cases with grade D,group BT has 15 cases,4 cases with grade B,1 case with grade C,10 cases with grade D.There were 24 cases of single segment lumbar spinal tuberculosis anterior surgery group(group AL),the average age was 32.0 years old,of which 12 were male and 12 were female.Posterior surgery group(BL group)included 28 cases,average 33.9 years old,of which 15 were male and 13 were female.There were 3 cases in group AL and 5 cases in group BL with great gravity abscess.In the group AL,4 cases were combined with the convex deformity,and the average post convex angle was 19.4°(13.5°~26.1°),there were 7 cases in the group BL,and the average post convex angle was 25.8°(13.2°~47.9°).The two groups of patients with neurological impairment were grade D,of which 10 cases of group AL;14 cases of group BL.The operation time,blood loss,ESR,CRP,the cure of tuberculosis and the complications of Group AT and group AL,group BT and group BL were compared and observed.The correction and maintenance efficiency of the two groups were assessed by imaging measurement.Through the VAS,ODI and SF-36 score comprehensive evaluation of the clinical efficacy of two surgical methods,the results were statistically analyzed.ResultsAll the cases were followed up for more than one year,and the average follow-up time was 20.2 months(12-36 months).The operation time,bleeding volume,average hospitalization time,complications,bone fusion rate of Group A(group AT,group AL)and Group B(group BT,group BL)was no significant difference(P>0.05).The lost of scoliosis,Group AT)BT group,the two groups were statistically significant(P<0.05).There was no statistical difference in the lost angle of scoliosis(P>0.05)between the two groups.In the angle of kyphosis and scoliosis,the angle of kyphosis and scoliosis correction,the correction rate of the kyphosis and scoliosis,the lost angled of kyphosis,the lost rate of kyphosis and scoliosis,There was no statistical difference between the Group A(group AT,group AL)and Group B(group BT,group BL)(P>0.05).There were no significant differences in ESR,CRP,VAS score,ODI score and SF-36 score between the two groups before and after the surgery and at the last follow-up(P>0.05).ConclusionAnterior and posterior approaches in the treatment of single segment thoracic and lumbar tuberculosis can achieve good curative effect,have the same security.The treatment of single segment thoracic tuberculosis by posterior approach is superior to anterior approach in scoliosis correction.Anterior surgical procedures have the advantages of clear focus and relatively open surgery,And posterior approach has the advantages of simple operation,less trauma and so on.Two kinds of operation can be used in the treatment of single segment thoracic and lumbar spinal tuberculosis,Operators can choose according to their own conditions and technical characteristics. |
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