| Objective To study the application of clearing the focus and the height of the anterior and middle column of titanium mesh in the treatment of thoracic tuberculosisMethods From January 2016 to July 2019,23 patients with thoracic tuberculosis were selected according to the inclusion and exclusion criteria,including 14 males and 9 females.The average age of the patients was 46 years.The focus of thoracic vertebrae was between 6 and 11 vertebrae,including 6 cases of tuberculosis involving single vertebrae,14 cases of double vertebrae and 3 cases of three vertebrae.All patients were treated with standard ntituberculous drugs before and after operation,and all patients were treated with the ethods of clearing the focus through the cross costal approach,and the anterior and middle column of titanium mesh grafting.The operation time,intraoperative hemorrhage,postoperative hospital stay and postoperative complications were recorded,and the VAS score,JOA score,hypersensitive C-reactive protein,erythrocyte sedimentation rate,Asia classification of neurological function and the value of kyphotic Cobb angle were compared before and at the last follow-up.Results All patients were followed up at different times.The average follow-up time was 15 months(8-25 months).The postoperative hospitalization time was(11.35 ± 4.21)d,the operative time was(264.62 ± 53.49)min,and the intraoperative bleeding volume was(463.24 ± 95.61)ml.ESR was(61.17 ± 17.36)mm / h before operation and(28.24 ± 13.51)mm / h one month after operation.ESR was(11.82 ± 5.31)mm / h at the last follow-up.CRP was(39.47 ± 14.51)mg / L before operation and(24.35 ± 9.57)mm / h one month after operation.CRP was(8.92 ± 2.71)mm / h in the last follow-up.The preoperative VAS score was(6.71 ± 1.92),and the last follow-up VAS score was(2.53 ± 1.41).JOA score was(17.54 ± 4.12)before operation and(24.54 ± 1.24)at the last follow-up.The Cobb angle of kyphosis was(35.72 ± 8.92)0 before operation and(17.35 ± 6.52)0 one day after operation.The last follow-up was(19.64 ± 7.72)0.After statistical analysis: the difference of ESR value and CRP value between the preoperative and the last follow-up was statistically significant(P < 0.05).There were significant differences in VAS score and JOA score before and at the last follow-up(P < 0.05).The difference of Cobb angle was statistically significant(P < 0.05).In terms of neurological function,the results of Asia classification before operation were as follows: class a 0 case,class B 1 case,class C 2 cases,class D 13 cases,class E 7 cases.At the last follow-up,the results of Asia classification were as follows: 0 cases of Grade A,1 case of grade B,1 case of grade C,1 case of grade D,21 cases of grade E.at the last follow-up,the neurological function of all patients was significantly improved compared with that before operation.All patients were treated with standard antituberculous drugs after operation,and there was no recurrence of tuberculosis during the follow-up period.During the follow-up period,there were no cases of loosening or falling off of internal fixation system.All the patients healed well during the follow-up period.The average healing time was(6.9 ± 1.1)months(7-11 months).Conclusion It is a better operative method to treat thoracic tuberculosis by the way of clearing the focus through the transverse approach and using the titanium mesh to implant the anterior and middle column to pad the height.The tuberculosis focus is completely cleared,the nerve function is obviously restored,the kyphosis is corrected obviously,the stability of the spine is well maintained,and the interbody fusion is good after the operation. |
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