| Objective: To compare and analysis the clinical effectiveness between bone-filled titanium mesh cage graft and iliac crest bone graft in the treatment of thoracic and lumbar tuberculosis with one-stage posterior debridement, bone graft, and internal fixation.Methods: From June 2012 to September 2014, the clinical data of 51 patients who suffered from thoracic and lumbar tuberculosis and treated in our hospital were retrospectively analyzed. They accepted the operation of one-stage posterior debridement, bone graft, and internal fixation. 25 patients in Group A had grafted with bone-filled titanium mesh cage and 26 patients in Group B had grafted with iliac crest bone. The operation time, bleeding volume, pre-operative and post-operative Frankel grade, ESR, the correction of kyphosis angle, the time of graft fusion at final follow-up were analyzed and compared between two groups.Results: Postoperative pathologic results confirmed tuberculosis in all patients. All patients were followed up from 6 to 30 months. There was one patient in Group A had tuberculosis recurrence and none in the other group. However,there were two patients in Group B who had hematoma and poor wound healing at iliac bone position. There was no complication like breakage of internal fixation and pseudoarticulation formation after operation in both groups. The time of bony fusion was 6 months to 12 months in Group A and 5 months to 12 months in Group B which showed no significant difference between these two groups(P>0.05).The average correction of kyphosis angle is 9.50±8.76° in Group A and 6.84±7.94° in Group B. The loss angle at the time of last follow-up is 1.68±3.96° in Group A and 1.95±3.02°in Group B. It was no significant difference to compare the improvement of Frankel grade, the correction of kyphosis angle and the loss angle(P>0.05). The average of operation time was 202.16±53.20 min and the hospitalization time was 30.44±9.30 days in Group A, while 282.27±65.26 min and 44.35±13.53 days respectively in Group B. The two in Group A were less than that of Group B and the difference is statistically significant(P<0.05). The mean bleeding volume was 712.40±419.34 ml in Group A and 951.92±799.69 ml which showed no significant difference between these two groups(P>0.05). The average preoperative of ESR was 60.76±20.19mm/h and 45.28±17.68mm/h one-week postoperative, 29.72±16.97mm/h three-months postoperative in Group A. However, the average preoperative of ESR was 53.69±31.69mm/h and 37.00±25.52mm/h one-week postoperative, 24.54±17.32mm/h three-months postoperative in Group B. It was no significant difference to compare the two groups’ ESR at the three points in time(P>0.05). The ESR was significantly decreased after operation. It was statistically significant difference to compare the ESR preoperative and postoperative(P<0.05).Conclusion:(1) It was safe and feasible to graft with bone-filled titanium mesh cagein the operation of one-stage posterior debridement and internal fixation for thoracicand lumbar tuberculosis. There was no significant difference in the clinical curativeeffect compare to iliac crest bone graft.(2) Compare with the group grafted with iliaccrest bone, the use of bone-filled titanium mesh cage could effectively reduce theoperation time and hospitalization time, avoid pain or hematoma in iliac crest, whilethe bony fusion time and corrective angle loss were similar.(3) One-stage posteriordebridement, bone-filled titanium mesh cage graft, and internal fixation for thoracicand lumbar tuberculosis could effectively correct the kyphosis angle and obtaininstant stability. The short term clinical curative effect was obvious, and the long-termeffects need further observation. |
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