Analysis Of The Curative Effect Of The Treatment Of Thoracic Tuberculosis By The Anterior Approach Of Stage ?,Bone Grafting From The Body Ribs,and Internal Fixation By The Posterior Approach Of Nail Rod System

Objective: To evaluate the curative effect of the treatment of thoracic tuberculosis by the anterior approach of stage I,bone grafting from the body ribs,and internal fixation by the posterior approach of nail rod system.Methods: A retrospective analysis was performed on January 1,2009,solstice,October31,2018,in the spine surgery department of our department and 309 hospital to treat a total of 30 patients with thoracic tuberculosis,including 18 male patients and 12 female patients,aged 18-70 years,with an average age of 55.8 years.Lesions involved two vertebral bodies in 12 cases,three vertebral bodies in 11 cases,and four or more vertebral bodies in 7 cases.Before surgery,19 patients presented or were admitted with low fever,night sweats,weight loss and other symptoms of tuberculosis poisoning;22 patients presented chest and back pain after minor trauma or no obvious trauma,and 1 patient had lumbago and sacral pain.Preoperative serum sedimentation rate was 58-126 mm /h,with an average of 83.2±20.9mm/h,c-reactive protein was 56-119,with an average of 87.1±17.0,Preoperative imaging examination confirmed the presence of 26 patients with thoracic spinal tuberculosis complicated with vertebral side abscess,preoperative thoracic vertebra protruding after Cobb Angle 27 ° ? 108 °,an average of 64.2 °,with 27 cases of spinal cord function and Frankel classification A level 7 cases,6 cases B,C grade 8 cases,D 6 cases,all patients were accepted stage I anterior lesion clearance,rib graft taken from the body,posterior screw rod system fixation treatment,The improvement of Cobb Angle,Frankel grading of nerve function,erythrocyte sedimentation rate and c-reactive protein were observed.Results: The mean operation time of the 30 patients was 4.45±0.35 h,and the mean intraoperative blood loss was 890 ± 130 ml.All patients had no intraoperative complications such as pleural tear and thoracic duct injury.After the operation,there were2 cases of continuous pain in the rib bone extraction area.After two months of symptomatic treatment with oral analgesia and neurotrophic drugs,the symptoms disappeared,and at the end of follow-up,there was no recurrence of pain symptoms.The anterior and posterior incisions of 29 patients were of stage I grade a healing.One patienthad poor postoperative healing of chest incisions and formation of sinus tract.After dressing change,debridement and other treatments,the incisions healed 3 weeks later.No major vascular and nerve injury was found in all patients,and no death was reported.2weeks after the operation,all the patients with low fever,night sweats and other symptoms of tuberculosis before the operation disappeared.Preoperative significant chest and back pain and lumbosacral pain disappeared.The follow-up time was 12 to 24 months,with an average of 17.3 months.Blood sedimentation rate and c-reactive protein returned to normal 2 weeks after the operation,and there were no recurrence cases of tuberculosis at the last follow-up.All the patients received bone grafting,and the longest healing time was 12 months.At 1 week after the operation,the Cobb Angle of kyphosis was 20° ? 35°,with an average of 24.9°;at the last follow-up,it was 24° ? 36°,with an average of 26.6°.All patients with neurological dysfunction had grade 1 or above recovery.Conclusion: The anterior approach of stage I lesion removal,bone grafting from the body ribs,and internal fixation of the posterior approach of nail rod system are effective surgical methods for the treatment of thoracic tuberculosis,which can effectively correct the kyphosis of the spine,rebuild the stability of the spine,completely remove the lesion,relieve the pressure on the spinal cord caused by abscess and dead bone,and promote the recovery of nerve function.