| Objective:To explore the effectiveness and advantages of the clinical application of sacral iliac screws and pelvic fixation in the treatment of lumbosacral spinal tuberculosis,compared with iliac screws and pelvic fixation techniques,Methods:A total of 34 patients were enrolled from December 2013 to December 2017,in The First Affiliated Hospital of Nanchang University and Orthopedic Hospital of Mianyang City in Sichuan Province,including 19 males and 15 females;aged 27-69years(average 52.2 years).All cases had varying degrees of lumbosacral pain and lower limb movement disorders,including 20 cases with lower extremity radiating pain,3 cases with intermittent claudication,one case with abscess sinus formation.All case were divided to IS group(14 cases of sacroiliac screw group)and S2 AI group(20 cases of the second sacral alar-iliac group)according to the different methods of spinal pelvic fixation.Formal anti-tuberculosis medicine treatment was given for at least 2-3 weeks before operation.All patients with lumbosacropelvic fixation were compared by recording with ESR/CRP,preoperative,postoperative 7 days and the last following up.The clinical effect oswestry disability index(ODI)score,visual analogue scale(VAS)and related complications of 2 groups were also compared.ResultAll patients were followed up for an average 22.5 months.The difference of erythrocyte sedimentation rate,between IS group and S2 AI group(62.4 ± 39.6 vs49.6 ± 42.9)mm / h at preoperative,(67.0 ± 34.0 vs 66.8 ± 37.2)mm / h at postoperative 7 days and(7.0 ±2.5 vs 6.6 ±1.4)mm / h at the final follow-up,was not statistically significant(P> 0.05).But there were significant differences between the groups in the preoperative,postoperative 7 days and final follow-up(p<0.05).The difference of C-reactive protein between IS group and S2 AI group(28.7±10.8 VS21.6±12.3)mg/lat preoperative,(39.9±24.1 VS 34.4±36.9)mg/l at postoperative 7days and(7.0±3.0 vs 6.0± 3.6)mg/l at the final follow-up,was not statistically significant(P> 0.05).But there were significant differences between the groups in the preoperative,postoperative 7 days and final follow-up(p<0.05).VAS in IS group decreased from 5.6 ± 0.9 preoperative to 1.9 ± 0.9(7 days after operation)and to 1.2± 0.7at the last follow-up,VAS decreased from 5.0 ± 1.4 preoperative to 2.1 ± 1.0(7days after operation)and to 1.1± 0.5 at last follow-up,which showed no significant difference between the two groups(P> 0.05).But comparisons within each group were differences(P <0.05).ODI in IS group decreased from 34.6±10.5 preoperative to8.0±1.5(7 days after operation)and to 4.6±2.3 at the last follow-up,ODI decreased from 29.1±12.8 preoperative to 8.6±3.6(7 days after operation)and to 4.5±2.2 at last follow-up,which showed no significant difference between the two groups(P>0.05).But comparisons within each group were differences(P <0.05).Hospitalization days(24.9 ± 6.4 vs 28.7 ± 9.5),fusion time(6.1 ± 1.6 vs 5.7 ± 1.5)months and drainage time(50.3 ±20.3 vs 48.8 ± 21.8)hours between the two groups were not statistically significant(P> 0.05),Reoperation rate(14.3% vs 0%),wound infection(21.4% vs 5%),plant bulge in the skin(21.4% vs 0%),mechanical pain(21.3%VS 15.0%),screw loosening(7.1% vs 0%)between IS group and S2 AI group were not statistically significant(P> 0.05).but the blood loss(1307.1±544.2ml in IS group,840.0±374.7mlin S2AIgroup)and operation time(255.8±53.0min in IS group,214.0±51.6min in S2AIgroup)were statistically significant(P<0.05).Conclusion:The clinical results of S2 AI screw and pelvic fixation technique for the treatment of lumbosacral tuberculosis were satisfactory.Compared with traditional iliac screws and pelvic fixation technique,it has the advantage of less intraoperative blood loss and shorter operative time. |
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