Analysis Of Clinical Effect Of Different Surgical Approach On Multi-segmental Thoracic And Lumbar Vertebral Tuberculosis

Objective Explore the result of multi-segmental thoracic and lumbar vertebral tuberculosis patients who uses debridement of different approaches,bone graft fusion and internal fixation.Method Having retrospective analysis of 40 cases of multi-segmental thoracic and lumbar vertebral tuberculosis patients in department of spine surgery,the First Affiliated Hospital of Xinjiang Medical University,Shanghai from 2010 and 2014.Choose different operation according to the lesion characteristics of the patients,abscess location,damage degree of vertebral body and whether the spinal cord compression is accompanied by the deformity of the posterior such factors.According to the differences of approaches,they are divided into three groups.A group: anterior debridement and bone graft fusion with internal fixation in 8 cases;B group: posterior debridement and bone graft fusion with internal fixation in 20 cases;C group: anterior debridement and bone grafting,one-stage posterior internal fixation in 12 cases.The Frankel grading of 40 cases patients: one case in B grading;6 cases in C grading;16 cases in D grading and 17 cases in E grading.29 cases of patients combined deformity,24 cases of Cobb angle 10 degrees-30 degrees and 5 cases of >30 degree.All patients are given standardized oral four(isoniazid,rifampicin,pyrazinamide,streptomycin sulfate)anti tuberculosis drugs for 2-4weeks and glucurolactone to protect the liver function at the same time before taking the surgery.Record the operation time,intraoperative bleeding,tuberculosis activity(ESR,C reactive protein changes),bone graft,titanium mesh fusion,location and recovery of neurological function and postoperative complications(including tuberculosis recurrence,pedicle screw and titanium mesh loosening)Cobb angle results of three patients and the analysis of grouping and sorting.Result The average operation time of A group is(3.6±0.5)h and the average amount of bleeding(431±44)ml;the average operation time of B group is(4.5±0.5)h and the average amount of bleeding(496±61)ml;the average operation time of C group is(4.7±0.6)h and the average amount of bleeding(557±63)ml.All of the patients have been soften in 5.5 days after operation.The average correction percent of the patients whose cobb is 10-30°is 53.7 ± 18.3%.The average correction percent of the patients whose cobb is more than 30°is 54.4±14.6%.ESR and C-reactive protein C-decreased gradually to normal in 3-9 months after operation.Conclusion The patients with multi-segmental thoracic and lumbar vertebral tuberculosis choose the reasonable operations according to the extent of the damage of each segment,size of abscess,and whether the spinal cord is associated with the posterior convex deformity and spinal cord compression such different factors after the regular anti tuberculosis drug treatment and they will be given complete focal debridement and bone graft fusion.Taking the rational,comprehensive and individualized treatment plan will have satisfying clinical effect.