| Objective:To comparing the clinical efficacy of one-stage debridement,interbody bone grafting,internal screw fixation and anterior debridement,interbody bone grafting,and posterior screw fixation for the treatment of thoracolumbar spine tuberculosis.Thoracic and lumbar spinal tuberculosis provides reasonable direction for clinical treatment.Methods:To collecte 70 cases of thoracic lumbar spinal tuberculosis patient data from October 2011 to June 2015 in our hospital,one period only approach lesions cleared intervertebral bone graft and internal fixation group(group A),38 cases,one stage anterior lesion clearance posterior internal fixation of bone graft group and 32 cases(group B).The two groups of patients in gender,age,lesion location,and number of segments are cumulative and preoperative Cobb Angle,nerve function damage degree,such as general data comparison,there was no statistically significant difference(P>0.05),and it was comparable.Detailed record of postoperative hospital stay,operation time,intraoperative blood loss,postoperative drainage volume,VS A score at the last follow-up,ASIA grade,Cobb angle,correction rate of kyphotic deformity,bone graft fusion time,postoperative Erythrocyte sedimentation rate and C-reactive protein(CRP)recovery to normal time,recurrence of tuberculosis and recurrence rate,complications,etc.,and these data were organized and statistical analysis.Result:The length of hospital time,operation time,intraoperative blood loss,and postoperative drainage in group A were lower than those in group B,and the difference was statistically significant(P<0.05);All patients in the two groups received 12 to 36 months,with an average of 16.3 months of follow-up.At the end of the last follow-up,both groups of patients had basically disappeared from the tuberculosis body and local symptoms,and no recurrence of TB was seen;The VSA score of the preoperative group A was(7.3±5.8),and the VSA score of the last follow-up was(1.2±0.9),the VAS score of group B before operation was(8.2± 1.4),and the VAS score at the end of the postoperative follow-up was(1.0±0.8),the comparison between the two groups was statistically significant(P<0.05),and the difference was not statistically significant(P>0.05).Two groups of preoperative patients with varying degrees of nerve dysfunction until the last follow-up improved 2～3 levels,two way contrast before and after the surgery,was statistically significant(P<0.05),the comparison between groups,there was no statistically significant difference(P>0.05).Preoperative Cobb Angle for group A(39.68±22.46)°,postoperative follow-up(17.49±11.82)°at the end of the time,group B(41.27±20.39)°preoperatively,at the end of the postoperative follow-up time for(19.23±13.16)°,after surgery in the group difference was statistically significant(P<0.05),there was no statistically significant difference between groups(P>0.05).The fusion time of bone grafting was 8～19 months,with an average of 13.5 months.Group B was 6～15 months,with an average of 12.8 months,with no statistically significant difference between the two groups(P<0 0.05).In group A,1 patient underwent surgical incision and 1 case of dural tear.Group B occurred in 1 case pulmonary infection with pleural effusion,3 cases of wound infection,patients with fistula formation,lower incidence of surgical complications of group A than group B,but statistically insignificant(P>0.05).Conclusion:One-stage posterior debridement and bone graft internal fixation and one-stage anterior debridement and bone graft posterior internal fixation for thoracolumbar spine tuberculosis can achieve satisfactory results,in the simple posterior group,the operation time,postoperative hospital stay,intraoperative blood loss,and postoperative drainage were all superior to the anterior and posterior joint groups,which had certain advantages. |
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