| Background:In recent years, the incidence of bone and joint tuberculosis tends increase, which accounts for about 50 percent of spinal tuberculosis systemic bone and joint tuberculosis, and tuberculosis is the thoracic and lumbar spinal tuberculosis predilection sites. Thoracolumbar tuberculosis patients can cause severe deformities, neurological dysfunction, and even paralysis, seriously affecting people’s health. At present, most minor tuberculosis can be cured by conservative treatment, but severe tuberculosis in the use of antituberculosis(TB) drugs and chemotherapy still need surgery to promote healing of tuberculosis, reconstruction of spinal stability, reduce disability and avoid and treat a variety of concurrent disease and improve the quality of life of patients with spinal tuberculosis.Objective:This paper aims to compare different treatment of bone single segment and multilevel segments results of operations of thoracic and lumbar tuberculosis through a retrospective to explore the titanium mesh, autologous iliac bone, allograft bone graft and interbody fusion in four ways clinical efficacy in the treatment of thoracolumbar tuberculosis. This retrospective analysis will provide clinical basis and evidence for the surgy treatment of thoracolumbar tuberculosis on the choice of technology and structural bone graft material.Methods:1.A retrospective analysis of single segment thoracolumbar tuberculosis patients in our hospital from January 2005 to May 2013 was treated. Object of study: the thorough debridement in TB treatment, based on the fusion and internal fixation for the treatment of patients with more than 24 months of follow-up record. Group: titanium mesh group(A) 29 cases; interbody fusion(group D) 26 cases; autogenous iliac bone group(group B) 32 cases; allogeneic bone group(group C) 25 cases. Clinical evaluation indicators: ① American Spinal Injury Association(ASIA) score grading; ② Cobb angle and the last follow-up loss situation; ③ fusion rate, using Bridwell evaluation criteria; ④ operation time; ⑤ blood loss; ⑥ hospital stay; ⑦ postoperative drainage; ⑧complication.Follow-up way: through outpatient follow-up, telephone and mail and other means. Compare the way: the group preoperative and postoperative follow-up period compared the same period comparison between groups.2.A retrospective analysis of cross-sections of our hospital from January 2005 to May 2013 was treated thoracolumbar tuberculosis patients. Object of study: the thorough debridement in TB treatment, based on the fusion and internal fixation for the treatment of patients with more than 24 months of follow-up record. Group: titanium mesh group(A group) 30 cases; autogenous iliac bone group(group B) 27 cases; allogeneic bone group(group C) 25 cases. Clinical evaluation indicators: ① American Spinal Injury Association(ASIA) score grading; ② Cobb angle and the last follow-up loss situation; ③ fusion rate, using Bridwell evaluation criteria; ④ operation time; ⑤ blood loss; ⑥ hospital stay; ⑦ postoperative drainage; ⑧complication.Follow-up way: through outpatient follow-up, telephone and mail and other means. Compare the way: the group preoperative and postoperative follow-up period compared the same period comparison between groups.Results:1. Included in the single case study segment 112 thoracolumbar tuberculos patients were followed up for 24 to 75 months, the average of months was 43.6. Four patients with postoperative nerve function were improved compared with the preoperative, but the difference was not significant(P> 0.05). Four groups of patients were compared with preoperative Cobb angle was significantly reduced(P <0.05), patients in each group lost degrees Cobb angle difference was not statistically significant(P last follow-up> 0.05). A, Group B fusion rate difference was not statistically significant(P> 0.05), A, C, D group, the difference was significant(P <0.05), A group higher than C, D groups. A, C, D group were operative time, blood volume less than group B, the difference was significant(P <0.05); A, C, D group operative time, blood loss, the difference was not significant(P> 0.05); four groups of postoperative drainage and hospitalization time difference was not statistically significant(P> 0.05).Compare complication rates between the four groups no significant difference(P> 0.05).Each group fusion at last follow-up,no bone graft material and fixation of loose or displaced.2. Cross sections included in the study, 82 patients were followed up for 24 to 72 months, average 45.5 months. Three groups of patients with postoperative neurological function were improved compared with the preoperative, but the difference was not significant(P> 0.05). Three groups of patients were compared with preoperative Cobb angle was significantly reduced(P <0.05), patients in each group lost degrees Cobb angle difference was not statistically significant(P last follow-up> 0.05). A, Group B fusion rate difference was not statistically significant(P> 0.05), A, C group, the difference was significant(P <0.05), A was higher than group C. A, Group C patients operative time, blood volume less than group B, the difference was significant(P <0.05); A, group C operative time, blood loss, the difference was not significant(P> 0.05); three groups of patients with postoperative drainage and hospitalization time difference was not statistically significant(P> 0.05).Compare complication rates between the three groups no significant difference(P> 0.05).Each group fusion at last follow-up,no bone graft material and fixation of loose or displaced.Conclusion:1.In this study, different structural bone graft material in a single segment, cross-segmental thoracolumbar tuberculosis treatment can get good clinical efficacy.2.Single segmental thoracolumbar tuberculosis treatment, the titanium mesh bone graft with autogenous iliac bone graft, bone graft fusion rate, but can effectively shorten the operation time, less intraoperative blood loss; Titanium mesh with allogeneic bone graft and bone graft Cage bone graft, operation time, intraoperative blood loss, no significant differences, but higher rate of bone graft fusion.3.Cross section in thoracolumbar tuberculosis treatment, the titanium mesh bone graft with autogenous iliac bone graft, bone graft fusion rate, but can effectively shorten the operation time, less intraoperative blood loss; Titanium mesh the allogeneic bone graft and bone graft operation time, intraoperative blood loss, there were no significant differences but higher rate of bone graft fusion.4.Titanium mesh is an ideal material to thoracolumbar tuberculosis bone graft, titanium mesh bone graft is a safe and effective for the treatment of thoracolumbar tuberculosis. |
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