Curative Effect Analysis Of Posterior Percutaneous Fixation Combined With Small Incision Anterior Approach Debridement For Thoracic And Lumbar Tuberculosis

Objective:To explore the curative effect of percutaneous fixation combined with small incision anterior approach debridement and bone grafting for thoracic and lumbar tuberculosis,and compare the results with the other three operation method respectively.Method:Retrospective analysis was performed on 80 cases of thoracolumbar and lumbar tuberculosis from September 2014 to January 2017 with debridement,bone grafting and internal fixation at the Chenzhou No.1 People's hospital.The range of lesions in all patients was in T8-L5.Four types of operation were used: Group A used the posterior minimally invasive fixation combined with small incision anterior approach debridement and bone grafting operation,with 12 cases;Group B with the anterior debridement and bone graft fusion internal fixation,with 22 cases;Group C with the posterior approach debridement and bone graft fusion internal fixation,with 31 cases;Group D used the posterior classical approach invasive fixation combined with anterior approach debridement and bone grafting operation,with 15 cases.Patients were treated with standard Anti-TB treatment for 2-4 weeks before operation,and continued the Anti-TB treatment for 12 to 24 months after surgery.Record and compare operation time,blood loss,volume of drainage.VAS score,ESR,Cobb angle,correction rates,correction loss angle,postoperative complications,postoperative ASIA,ODI,fusion of bone graft and other indicators in different four groups.Result: All the 80 cases were followed up for 12-30 months with an average follow-up of 15 months.In group A,the average time of operation was(3.6±0.4)h,blood loss(232.1±76.5)ml,the volume of drainage was(192.6±62.2)ml,correction rate(56.6±11.8)%;Group B,the average time of operation was(2.9±0.6)h,blood loss(375.2±128.2)ml,volume of drainage was(261.9±70.9)ml,correction rate(45.2±14.2)%;Group C,the operation time was(3.4 ± 0.6)h,blood loss(497.1 ± 175.3)ml,volume of drainage was(296.5 ± 90.8)ml,correction rate(53.4 ±10.1)%;the operation time,blood loss,volume of drainage and the correction rate of group D was(3.5±0.5)h,(348.4±117.8)ml,(267.1±71.5)ml,(57.6±13.5)%.The loss angles of A,B,C and D in the last follow-up were respectively(1.8 ± 0.6,2.7 ± 1.0,2.2 ± 0.8,1.8 ±1.1)°.The operation time in group B was the least in the four groups,while there was no significant difference in the operative time among group A,C and D.Group A was less than B,C and D in the amount of bleeding and postoperative drainage,and the difference was statistically significant.On the correct rate and postoperative correction loss Angle,there was no statistically significant difference between group A and C and D,group A was better than group B in correction rate,and the loss angle was less than group B,and the difference was statistically significant.Two weeks after operation,the VAS of the four groups were lower than those before surgery,and group A was less than C and D,the difference was statistically significant.In the three months after surgery,VAS in each group were less than before,and group A was less than C and D,the difference was statistically significant.Follow up to 6-12 months after operation,the VAS of all groups continued to decline,and there was no significant difference between group A and the other three groups.The ODI in each group,there was no significant difference between 2 weeks after surgery and before operation.At the 3 months after the operation,the ODI of four groups were less than the former,and group A was less than the other three groups,the difference was statistically significant.The ODI of the four groups continued to decline in 6-12 months after the operation,and there was no significant difference among the group A and the other three groups.In 11 patients with spinal cord disorders,the ASIA score increased by a level and 1 case increased by 2 level after operation.Postoperative patients with review of the ESR,2-3 weeks began to decline,and most postoperative patients returned to normal after 3-6 month.Group A,B and D,1 cases of wound infection in each group(all of them were anterior incision),and 1 case of group C appeared wound sinus in 1 month after surgery.In group C,1 case was found internal fixation loosened within 2 years after operation,but the fusion of bone graft was good.One patient in group C had a recurrence after 8 months.No significant complication occurred after the other cases.Conclusion:(1)under the standard effective anti-tuberculosis treatment,strictly grasp the operation indication,the detailed preoperative preparation and careful intraoperative operation,the four different operation method can achieve satisfactory recent and medium-term clinical curative effect.(2)The operation of posterior percutaneous fixation combined with anterior approach debridement and bone grafting for the treatment of T8-L5 segment spinal tuberculosis is more advantageous than the other three classic methods in bleeding amount and volume of drainage.In the convex orthopaedic and maintain corrective ability is better than that of classic anterior surgery.This method has advantages over the other three operations in early postoperative functional recovery and postoperative pain.This mode of operation is a safe and effective surgery for the treatment of thoracic and lumbar tuberculosis.It can be used as one of the approach for anterior and posterior combined minimally invasive treatment of thoracic and lumbar tuberculosis.