| Objective:By comparing with traditional anterior-posterior approach surgery,the clinical efficacy and safety of debridement only through posterior approach and structural reconstruction with titanium mesh cage in treating thoracolumbar tuberculosis was evaluated.Methods:86 patients with thoracolumbar tuberculosis were reviewed retrospectively to analyze the clinical results from the First Affiliated Hospital of Nanchang University from September 2013 to February 2016.Of these,42 cases were treated with debridement only through posterior approach and structural reconstruction with titanium mesh cage(A group),while other 44 cases were treated with anterior debridement and interbody fusion associated with posterior approach screw-rod fixation(B group).Operation time,blood loss,the time of the first intestinal ventilation after surgery,hospital duration,hospitalization expenses(except the cost of instrumentation),time of re-ambulation,bone graft fusion time were compared between two groups;VAS score(preoperative and postoperative 3 days,7 days and 1 month),JOA score and ODI score(preoperative,postoperative 3 months,the last follow-up),cobb angle correction were compared between two groups.Complications were also recorded.Results:All patients were followed up for 14 to 36 mons(average of 27.3±8.62 mons).In group A,the bone graft fusion time was 8.24±1.36 mons,the JOA score was 20.86±2.62 three mons after surgery and 25.12±2.42 at last follow-up,the ODI score was 19.98±2.05 three mons after surgery and 8.93±3.47 at last follow-up,the blood loss was 891.79±373.57 ml,the local cobb angle correction was 9.33±2.69°.In group B,the bone graft fusion time was 8.77±1.43 mons,the JOA score was 20.84±3.54 three mons after surgery and 24.11±2.81 at last follow-up,the ODI score was 20.70±2.62 three months after surgery and 10.20±4.17 at last follow-up,the blood loss was 940.91±403.80 ml,the cobb angle correction was 8.72±2.20°.There were no significantly differences between two groups in bone graft fusion time,JOA score,ODI score,blood loss,Cobb angle correction(P>0.05).In group A,the operation time was 200.86±70.75 mins,the hospital duration was 13.14±3.07 d,the time of the first intestinal ventilation after surgery was 17.14±4.92 h,the hospitalization expenses were 24306.14±5621.39 RMB,the VAS score was 6.05±0.85,3.60±0.89 and 1.76±0.743 at 3 days,3 days,7 days and 1 mon after surgery.The time of re-ambulation was 3.33±1.00 d.In group B,the operation time was 365.34±95.70 min,the hospital duration was 16.84±4.37 d,the hospitalization expenses were 24306.14±5621.39 RMB,the average time of the first intestinal ventilation was 21.93±5.5h after surgery,the VAS score was 6.61±0.99,4.23±1.05 and 2.25±0.87 at 3 days,7 days and 1 mon after surgery respectively.The time of re-ambulation was 5.02±1.66 d.There were significantly differences between two groups in operation time,hospital duration,the time of the first intestinal ventilation after surgery,hospitalization expenses,time of re-ambulation,VAS score(P>0.05).All patients achieved clinical healing standards,no back or lower back pain symptoms,well-recovered nerve function.In group B,one case recured with sinus formation 3 mons after surgery.,Bone graft donate region infection occurred in a patient 6 days after surgery.In group A,one cases showed slight subsidence of the titanium mesh 3 mons after operation,but did not aggravate at follow-up.Conclusions:Debridement only through posterior approach and structrural reconstruction with titanium mesh cage can achieve the same satisfactory clinical results compared with anterior-posterior approach surgery in treating thoracolumbar tuberculosis.However,the surgrical trauma is less than anterior-posterior approach surgery.This technique can effectively shorten hospitalization time,operation time,postoperative re-ambulation time,reduce hospitalization expense and postoperative complications.So this method is a safe and effective surgery to treat thoracolumbar tuberculosis. |
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