Clinical Observation Of Posterior Approach Fixed Bone Graft Fusion For Lumbar Brucellosis Spondylitis

Objective : In order to observe the clinical value of posterior pedicle screw fixation,lesion removal and intervertebral bone graft fusion in the treatment of one-stage lumbar brucellosis spondylitis.Methods : A retrospective analysis from June 2016 to July 2019 in general hospital orthopedic spine diagnosis for brucella spondylitis,and did the posterior fixed by bone graft fusion and posterior pedicle screw fixation with the lesions cleared with intervertebral bone graft fusion in treatment of one segmental lumbar brucella spondylitis patients.There were 34 patients in part A,25 males and 9 females,average age in 40-74 years(55.5±10.3)years old and segments of T12-S1.A total of 29 patients were included in part B,23 males and 6 females,average age in 30-73 years(51.2±10.0)years and segments same as part B.Patients who both parts were treated strictly according to the standard drug therapy regimen before and after surgery.Operation-related conditions,such as operative time,intraoperative blood loss,postoperative drainage volume,and length of stay,were recorded in the two parts.At the same time,the following indexes were observed to evaluate and analyze the efficacy:preoperative/postoperative Temperature,White blood cell count,ESR,CRP,VAS score,JOA index,Cobb Angle;According to Bridwell standard of bone graft fusion combined with CT,the bone graft fusion was assessed in the last follow-up.Results:Patients in both parts were followed up for 1 year or more,in which part A was followed up for 12-22 months,16.1±2.8 months and part B was followed up for 12-22 months,16.5±3.2 months.During the visit,there were no accidents such as internal fixation detachment,fracture or loosening,and no cases of focal recurrence.Compared with part B,the operative time 102±25min,intraoperative blood loss 172±98ml,length of hospital stay 13.59±3.61 days,postoperative time to ground 5.91±2.53 days and postoperative drainage volume 245.26±85.34 ml of part A were obviously reduced,and the difference between the two part was statistically meaningful(P<0.05).Intra-parts comparison of pain indicators between part A and part B was conducted before surgery and 3 months after surgery.Evaluation indexes were as follows:(1)Comparison of VAS scores between the two parts showed statistically significant differences(t=16.447,P=0.000;t =17.306,P=0.000);(2)The difference of JOA scores between the two parts was statistically significant(t=19.952,P=0.000;t=14.974,P=0.000);The incision healing was good at outpatient review 1 month after the operation.Between two parts comparison of laboratory infection indexes between part A and part B before surgery and 3 months post surgery:(1)Temperature,White blood cell count between the two parts was different,which statistically significant(P<0.05);(2)The difference in ESR and CRP value between the two parts was statistically significant(P<0.05).Postoperatively,deformities in both parts were well corrected.In part A,the Cobb Angle measured before surgery,3 months after surgery and the last follow-up were compared,and the difference was statistically significant.Conclusion : Posterior fixation has the advantages of less tissue trauma,short operation time,quick postoperative recovery and good effect of bone graft fusion in the treatment of single level lumbar brucella spondylitis.