The Clinical Research Of Wiltse Approach One-stage On The Removal Of Lumbar Vertebrae Tuberculosis And Psoas Abscess

Objective:To investigate the feasibility and analyse the clinical effects of Wiltse approach one-stage to remove lumbar vertebrae tuberculosis and drain psoas abscess.Methods:Retrospective analysis of operative methods all applied Wiltse approach one-stage to complete the debridement,absecess drainage,vertebral fusion and pedicle screw internal fixation.According to the clinical data of 19 cases of lumbar vertebrae tuberculosis and psoas abscess removal from Nov.2012 to May 2016,among whom 8 men and 11 women range in age from 26 to 64 with an average of 44�9.9.All patients were treated with the standard preoperative anti-tuberculosis durgs for 2-4 weeks and the regular post-operative chemotherapy for 12-18 months.The data were observed by the time,blood loss in operation,blood loss after operation and drainage tube extraction time.13 patients suffered from different degrees of neurologic impairment before the operation.Based on ASIA,there were 3 cases of grade B,4 cases of grade C and 6 cases of grade D.The preoperative ESR and CRP were 63.7�11.8mm/h and 16.9�3.54mg/L repectively.The kyphosis cobb angle was 26.9o�2.9o.The score of visual analogue scale(VAS)evaluates the improvement of postoperative lumbago.Patients' neural functions were assessed by applying American Spinal Injury Association(ASIA)one year after the operation.The kyphosis cobb Erythrocyte Sedimentation Rate(ESR)and the detection value level of CRP were monitored in the preoperation,postoperation and the follow-up.The effect of kyphosis correction and disease control were observed.Additionally the internal fixation was measured by X-ray,CT reconstruction and MRI.The bone fusion and the extinction time of psoas abscess were also recorded.Results:All patients were operated smoothly.Operation time was 121~260 min,with an average of(194�40)min;operative blood loss was 254~580ml,with an average of(410�80)ml.Drainage volumn was 213~477 ml after surgery with an average of(340�68)ml.The drainage tube extraction time was 4~10d with an average of(6.7�1.8)d.All patients were followed up for 12-36 months with an average of(22�7.0)months.The patients with neurologic impairment before the operation recovered to ASIA 1-3 and others without the symptom were not aggravated after the operation.The decline of VAS illustrated that lumbago was greatly improved.The kyphosis cobb angle was 8.7o�1.9o with an average correction of 18.2o compared with the preoperation and there was 1o~3 loss of kyphosis correction in the one-year follow-up.ESR and CRP returned to the normal level in the 6 months of operation.No internal fixation loosened,fractured or collapsed by X-ray,CT reconstruction and MRI.The intervertebral bony fusion was achieved and the fusion time was 4-12 months with an average of(7�2.3)months and no joint formation was found.Psoas abscess vanished within 8 months of operation with an avergage of(7�1.1)months.There was one case of postoperative cerebrospinal fluid leakage and was cured by ensuring the drainage tube patency and prolonging indwelling time in collaboration with an effective symptomatic treatment.There was one case of incision disunion after two weeks of the operation.The patient was healed by another surgi cal debridement and drainage irrigation,plus anti-infective agents ten days later.Until the last follow-up,no recurrence of tuberculosis was found.Conclusion:It is a feasible and effective operation method by applying Wiltse approach one-stage to remove lumbar vertebrae tuberculosis and psoas abscess with definite clinical effect.