Discussion On Clinical Characteristics?classification And Posterior Approach Treatment Of Lumbosacral Junction Tuberculosis With Kyphosis

Objective:To review and analyze the clinical data of lumbosacral junction tuberculosis patients,analyze the correlation between pathological changes and imaging characteristics,Put forward a new classification,and evaluate the feasibility and effectiveness of posterior approach surgery for lumbosacral junction tuberculosis with kyphosis;Methods:From April 2013 to May 201 9,we retrospectively analyzed 16 patients with lumbosacral junction tuberculosis with kyphosis who were treated in our hospital The clinical data of patients are retrospectively analyzed.The visual analogue score?ODI?and the Japan Orthopaedic Association?JOA?score were used to evaluate the clinical symptoms at pre-operation,after-operation and the follow-up;Obtain the imaging examination data including X-ray,CT,MRI of all patients at pre-operation,after-operation and the follow-up.The deformity angle,kyphosis angle,lumbosacral angle,and vertebral body damage index of all patients were recorded at pre-operation,after-operation and the follow-up to evaluate the orthopedic effect of operation;All patients were treated with posterior debridement,decompression of spinal canal,orthotics,titanium mesh reconstruction and screw rod system internal fixation.All data were processed by statistical method.Results:There were 16 patients in this group,with an average age of 28 years?15-44 years?,10 males and 6 females;the average course of disease was 17 months?4-108 months?.All patients were admitted to the hospital with low back pain and lumbosacral deformity.Among them,9 patients were accompanied by systemic tuberculosis poisoning symptoms;6 patients were accompanied by sensorimotor dysfunction of the lower extremity;1 patient was grade B according to ASIA,and 1 patient was grade C 4 cases,grade D,the rest are grade E;all patients were followed up for 12 to 36 months,with an average of 19 months.Preoperative patients had a VAS score of 5.18 ± 1.94 points,a JOA score of 15.81 ± 4.59 points,preoperative kyphosis angle of this group of patients was 0.87 ± 28.46,deformity angle was 4.06 ±22.38 °,and lumbosacral angle was 14.12 ± 18.49°;involved Segment:10 patients with L5-S1 segment,3 patients with L4-S1 segment,1 patient with L4-S2 segment,1 patient with L5-S2 segment.and 1 patient with L2-S1 segment;All patients were followed up for 12 to 36 months,with an average of 19 months.The operation time was 140-250min,with an average of 183min.The intraoperative blood loss was 400-800ml,with an average of 586ml.The intraoperative blood transfusion ranged from 0 to 600 ml,with an average of 260 ml.Two patients experienced perioperative complications.One patient's ASIA classification improved from C to D at the last follow-up.All other patients had ASIA classification of E at the last follow-up.No internal fixation failure or pseudoarticular joint formation occurred during the follow-up.The preoperative VAS score was 5.18 ± 1.94,the JOA score was 15.81 ± 4.59,the VAS score at the last follow-up was 2.12 ± 1.26;and the JOA score was 21.93±4.52.The VAS and JOA scores of all patients in this study at the last follow-up were significantly lower than before surgery,and the difference was statistically significant?P<0.05?.The kyphosis of this group of patients was 0.87 ±28.46 before surgery,18.12 ± 16.4 ° after surgery,and the last follow-up was 17.75 ±16.25 °.The deformity angle of this group of patients was 4.06 ± 22.38° before surgery,19.75 ± 12.45 ° after surgery,and the last follow-up was 20.00± 12.85;the lumbosacral angle of this group of patients was 14.12± 18.49 ° before surgery,25.21± 9.71° after surgery,and 24.71 ± 9₃1° at the last follow-up.The postoperative kyphosis angle,deformity angle and lumbosacral angle of the patients in this group were significantly higher than those before surgery,and the differences at different time points were statistically significant?P<0.05?.The differences before surgery and last follow-up were statistically significant?P<0.05?.<0.05),there was no significant difference between the postoperative and the last follow-up?P>0.05?;There was no statistical significance correlation between the deformity angle,kyphosis angle,lumbosacral angle and the course of disease?P>0.05?,but there was statistical significance correlation between the vertebral destruction index,JOA score and the course of disease?P<0.05?.the correlation between the vertebral destruction index and the JOA score was not statistically significant?P>0.05?;The correlation between kyphosis,lumbosacral angle and JOA score is statistically significant?P<0.05?,and the correlation coefficients of deformity angle,kyphosis,lumbosacral angle and JOA score?0.4<R<0.75?indicate kyphosis There is a moderate correlation between the deformity angle,deformity angle,and JOA score,and the correlation between the deformity angle is higher than the kyphosis angle and lumbosacral angle.The imaging classification of kyphosis of lumbosacral junction tuberculosis was proposed.Based on the patient's disease characteristics,course and imaging data,preliminary imaging' classification of lumbosacral junction tuberculosis kyphosis simple type?type ??,progressive destruction type?type ??,bone disease curing type?type ??,Type ? is divided into three subtypes of ?a,?b,?c according to the severity of the deformityConclusion:There was a significant correlation between the vertebral body damage index,JOA score and the course of disease;among the four Imaging indexes,the deformity angle,kyphosis angle and lumbosacral angle had a moderate correlation with the severity of the patients' clinical symptoms,and the correlation between the deformity angle and JOA score was the most clear,which could be used as a reference index to evaluate the patients' clinical symptoms.The classification presented in the discussion is simple,easy to remember and has obvious characteristics,which has certain reference and guiding significance for the clinical diagnosis and treatment of lumbosacral tuberculosis with kyphosis.It is effective and safe for posterior approach to complete clearance of focal lesion,sagittal sequence reconstruction and internal rigid fixation.