Preliminary Study Of Posterior Intervertebral Debridement, Bone-graft Fusion And Internal Fixation For Lumbosacral Tuberculosis

Background:Currently,the report of one-stage posterior internal fixation,anterior radical eradication,bone graft fusion is more,and it take two surgical incisions,and it is necessary to change position in the operation.It causes major trauma,and takes long time and money. Posterior intervertebral debridement, bone-graft fusion and internal fixation is rarely reported, It takes single-incision, and technical requirements are relatively simple, for some patients with lumbosacral tuberculosis,it is another choice.Objective Retrospective study the therapeutic efficacy of the patients with lumbosacral tuberculosis with one-stage posterior internal fixation,anterior radical eradication,bone graft fusion and posterior intervertebral debridement, bone-graft fusion and internal fixation,compared with one-stage posterior internal fixation,anterior radical eradication,bone graft fusion to investigate features and clinical indication of posterior intervertebral debridement, bone-graft fusion and internal fixation in treatment of the lumbosacral tuberculosis.Methods Retrospective study the patients with lumbosacral spinal tuberculosis in Xiang Ya Hospital from January 2002 to October 2009.According to the patient's condition, we take two methods:posterior intervertebral debridement, bone-graft fusion and internal fixation (group A)and one-stage posterior internal fixation,anterior radical eradication,bone graft fusion(group B).Group A contains 14 cases,8 males and 6 females.the average age was 45.6 years(from 22 to 62 years),Group B contains 16 cases,7 males and 9 females,the average age was 41.9 years(from 24 to 65 years).General support and preoperative anti-TB treatment, Preoperative exclusion of active pulmonary tuberculosis。Collect each group imaging datas before and after the surgery and operation time, blood loss, hospital stay, hospital cost. Periodic follow-up to observe the change of ESR,and shoot the picture of X-ray,CT three-dimensional reconstruction to evaluate the situation of tuberculosis activity, bone fusion and deformity correction.Results There were no main vessel and nerve injury and serious complications in the operation.The average Lumbosacral angle of the preoperative was(19.2±3.9)°(Group A) and(18.6±3.4)°(Group B),and that of postoperative was (24.9±4.7)°(Group A) and (25.4±3.3)°(Group B)。The average Lumbosacral angle was (23.5±4.7)°(Group A)and(24.1±3.2)°(Group B)at the late follow-up.Each group had the statistical significance between preoperative and postoperative as well as late follow-up(P<0.01)。The loss angle of group A at late follow-up was 1.5°,and 1.4°in group B.No statistical significance(P>0.05)between two groups in the loss angle.The average operation time was 189 mins(Group A) and 233 mins (group B).The average blood loss during the operation was 454 ml(group A) and 888 ml (group B).The average hospital stay was 26.1 days(group A) and 26.3 days(group B),The average hospital cost was 69 thousands yuan (group A) and 74 thousands yuan (group B).The improvement rate of clinical efficacy was 85.7% (group A) and 87.5%(group B).There is statistical significance between two groups in operative time,blood loss, hospital cost(P<0.01),no statistical significance in clinical efficacy and hospital stay(P>0.05).The ESR of preoperation average 45.0±26.5mm/h (range 13-98mm/h), The ESR of follow-up average 9.1±1.9mm/h(range 6-12mm/h),the time of bone-graft fusion average 5.9±0.7months (rang 5-7 months)(Group A). The ESR of preoperation average 59.7±27.9 mm/h(range 12-110mm/h), the ESR of follow-up average 8.4±1.8mm/h(range 6-14mm/h),the time of bone-graft fusion average 4.1±1.0 months(rang 3-6 months)(Group B). Follow-up average 20 months (rang 6-24 months), all the cases have no TB recurrence, fixation loosening,and fracture。Conclusion One-stage posterior internal fixation,anterior radical eradication,bone-graft fusion and posterior intervertebral debridement, bone-graft fusion and internal fixation are effective to treat lumbosacral tuberculosis.Posterior intervertebral debridement, bone-graft fusion and internal fixation needs a less demanding operative technique,it can reduce the time of operation and the hospital cost, the Subsequently accompanied trauma,and its bone-graft fushion time is longer than that of one-stage posterior internal fixation,anterior radical eradication. Its surgical indications should be strictly controlled.