| Objective:To compare the clinical efficacy of one-stage posterior osteotomy removal and orbital scraping debridement in clinical treatment of thoracolumbar tuberculosis,and to explore the clinical effectiveness and superiority.of one-stage posterior osteotomy debridement in the treatment of thoracolumbar tuberculosis.Methods:Retrospective analysis of the treatment outcomes of 148 patients with thoracic and lumbar tuberculosis treated surgically in our department of orthopedics from November 2013 to January 2017,of which 35 patients were treated with one-stage posterior osteotomy(Group A),113 patients were treated with a posterior orbital scraping lesion(Group B).The operative time,intraoperative blood loss,intraoperative hemoglobin infusion(including 3 days after surgery),bed rest time,C-reactive protein,bone fusion time,preoperative,postoperative,and last follow-up of ESR preoperative and postoperative(January and March)VAS scores,preoperative and postoperative(March and final follow-up)JOA scores,preoperative and postoperative(March and final follow-up)ODI scores,Preoperative and postoperative(7-day and final follow-up)lobe angle and degree of kyphosis correction,and record complications and recurrence were compared between group A and group B,the above data were analyzed statistically.Results:All patients were followed up for 10-36 months and the average follow-up time was(17.78 ± 6.59)months.The operation time in group A was(278.97±81.40)minutes.The intraoperative blood loss was(900.00±500.00)ml.Intraoperative(including 3 days after surgery)infusion of suspended red blood cells was(1.89±1.60)units,The bed rest time was(5.06±3.00)days.Bone fusion time was(7.60±1.45)months.Postoperative erythrocyte sedimentation rate was(78.14±38.70)mm per hour.At the last follow-up,the erythrocyte sedimentation rate was(14.46±5.82)millimeters per hour.The C-reactive protein was(43.18±28.54)micrograms per milliliter after surgery.The C-reactive protein was(6.44±2.62)micrograms per milliliter at the final follow-up.The VAS score at 1 month after surgery was(1.20±0.41),the VAS score at 3 months after surgery was(0.94±0.42),the JOA score at 3 months after surgery was(26.60±1.58),and the final follow-up JOA score was(27.89±1.05),ODI score was(19.78±7.22)% 3 months after operation,ODI score was(12.03±4.66)% at the last follow-up,Cobb angle was(11.54±9.59)degrees after operation,and Cobb angle was(11.71±9.45)degrees at the last follow-up,the Cobb angle correction is(5.54±4.91)degrees,Three of these patients had postoperative complications.None of the patients had recurrence after surgery.In group B,the operation time was(247.56±75.75)minutes,the intraoperative blood loss was(594.12±265.10)milliliters,and the amount of suspended red blood cells infused during operation(including within 3 days after surgery)was(1.10±1.55)units.The bed rest time was(16.21±12.61)days,bone fusion time was(8.20±1.57)months,postoperative erythrocyte sedimentation rate was(61.10±31.66)mm/hour,and the last follow-up was(13.73±4.71)mm/hour.The post-C-reactive protein was(41.92±34.11)micrograms per milliliter,and the final follow-up C-reactive protein was(6.12±2.77)micrograms per milliliter.The VAS score at 1 month after surgery was(1.32±0.63).The VAS score at 3 months after surgery was(0.81±0.44).The JOA score at 3 months after surgery was(25.36±5.20).The final follow-up JOA score was(26.38±4.98),ODI score was(24.06±17.00)% 3 months after operation,ODI score was(17.07±15.53)%,postoperative Cobb angle was(10.80±7.33)degrees,and the last follow-up Cobb angle was(10.76±6.86)degrees,the Cobb angle correction degree is(4.49±3.93)degrees,Thirty patients had surgical complications and 11 patients had recurrent tuberculosis.Four patients underwent debridement again.Comparing the above data,the A group and the B group at the final follow-up of ESR,C-reactive protein after surgery,C-reactive protein at the last follow-up,VAS scores at 1 and 3 months after surgery,JOA score at 3 months after surgery,ODI score at 3 months after surgery and the final follow-up,Cobb angle correction,There was no statistical difference in the above data(P>0.05).Operative time,amount of blood loss during surgery,amount of infused red blood cells,bed time after surgery,bone fusion time,erythrocyte sedimentation rate after surgery,postoperative complications,and recurrence after surgery,There was a significant difference between the two groups(P<0.05).Conclusions:One-stage posterior osteotomy lesion removal for the treatment of thoracolumbar tuberculosis can achieve the same clinical efficacy as that of orbital scraping lesion removal.Although the amount of blood loss during surgery increases and the operation time increases,However,the patient's bed rest time and bone fusion time were shorter,and the operative complications and recurrence rate were significantly reduced.This surgical procedure is safe and effective for the treatment of thoracolumbar tuberculosis,and provides spinal surgeons with better surgical options in the treatment of spinal tuberculosis. |
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