| Research background:Currently,global tuberculosis incidence rate showed an increasing trend. The existing 20 million TB patients worldwides. There are an annual increase of 800-1000 million wodewide and TB deaths every year is about three million. China is the world's 22 TB high-burden countries, with the second number Tuberculosis cases in the world. Bone and joint tuberculosis is a common secondary pulmonary tuberculosis, Half of which involved the spine. Because of its relatively high morbidity, According to the reported incidence of paraplegia of spinal tuberculosis is 20%. Which Affect the quality of life of patients very much, the treatment is quite difficult.Patients with spinal tuberculosis with paraplegia, Generally speaking, accept surgery subject to regular anti-TB preoperative anti-TB treatment for 2-4 weeks waiting for a stable condition,until their Body temperature, ESR, hemoglobin returned to normal range. However, these patients often take a long time before conservative treatment condition gradually. Prolonged therapy increase the burden on patients and increase the time patients stay in bed, Even some patients are not clear due to abscess, tuberculosis symptoms difficult to improve, abscess rupture. Bring the trouble to the treatment of spinal tuberculosis. Therefore, some scholars pointed out that the spinal tuberculosis with paraplegia spinal cord compression should be lifted early surgery to prevent irreversible changes in its operation to lose the best opportunity.Research purposes:during the treatment of spinal tuberculosis with paraplegia, By the different timing of surgical intervention, review of preoperative and postoperative biochemical changes and nerve function, evaluation of the security operation ahead of time and effectiveness.Methods:There are 84 patients with thoracic spinal tuberculosis with paraplegia accept surgery and received follow-up data in our department since January 2003 a total of-2,009 in March,44 patinta inOne group (A group),they accept the conventional quadruple anti-tuberculosis treatment for 2-4 weeks or longer until the ESR,CRP, body temperature dropped to normal before the surgery,while The other group (B group) accept chemotherapy for less than 1 week (4danys) before surgery. In addition to anti-tuberculosis quadruple, they accept the plus isoniazid 0.2g (Bid)intravenous infusion 3 days before surgery. After the,surgery,two groups continue to quadruple anti-TB for 18 months. Wear a brace to protect for more than a year. Periodic review of plain film X After discharged(three months, six months, one year after discharged, review once every six months after),Review body temperature, ESR, CRP(2 days,one week,one month,three months after discharged, review once every six months after), review Neurological function(one week,one month,three months,half a year after discharged, review once every six months after). Under review the biochemical, clinical manifestations, imaging compared with the preoperative. Each patient had received an average of 20 months of follow-up(12-36months).Result:Disseminated Mycobacterium tuberculosis in all cases postoperatively, no recurrence, no internal fixation loosening, the body temperature returned to normal levels one week after the surgery. ESR, CRP and other indicators decreased significantly after the surgery, which return to normal levels one month later. Neurological function of Patint in A group recovery 1.2 levels average(1-3 level) half a year after the surgery, while Neurological function of Patint in B group recovery 2.6 levels average(1-4 level) half a year after the surgery.Conclusion:For patients with spinal tuberculosis with paraplegia, After a short period of time as long as an effective anti-TB treatment (less than 2 weeks), as long as the ESR, CRP and other biochemical indexes were decreased, patients is generally good, and there is no absolute surgical contraindications,Patients recept surgery in advance not wait until the ESR, CRP fell to normal levels is relatively safe,there is no significant effect on recurrence to postoperative cure of spinal tuberculosis with paraplegia. And in this context, Patients recept surgery in advance as long as an effective anti-tuberculosis can significantly improve the recovery of neurological function after surgery, can reduce the hospitalization period, reducing the long-term bed rest due to complications resulting from, and can reduce the financial burden of patients. |
