Objective To evaluate the cl inical effectiveness and advantages of one-stage posterior debridement, bone graft, and internal fixation for thoracic tuberculosis. Methods The data were retrospectively analysed, from 21 cases of thoracic tuberculosis undergoing one-stage posterior debridement, bone graft, and internal fixation between June 2007 andNovember 2009. There were 16 males and 5 females with an average age of 42.2 years (range, 22-73 years). The average disease duration was 13.2 months (range, 7-21 months). The lesions were located at the level of T5, 6 (1 case), T6, 7 (1 case), T8, 9 (4 cases), T9, 10 (3 cases), T10, 11 (5 cases), T11, 12 (6 cases), and T9-11 (1 case). According to the Frankel grading criterion, the neurological function was rated as grade B in 2 cases, grade C in 6 cases, grade D in 10 cases, and grade E in 3 cases. The preoperative Cobb angle was (26.3 ± 9.2)°. The erythrocyte sedimentation rate (ESR) was (35.9 ± 11.2) mm/ 1 hour. Results Thoracic tuberculosis was confirmed in postoperative pathological examination in all 21 cases. All incisions healed primarily without fistules formation. The average follow-up time for 21 patients was 16.2 months (range, 1-3 years). Bony fusion was achieved within 7-12 months (mean, 9 months) without pseudoarthrosis. No loosening and breakage of internal fixation were found, and no local recurrence occurred. The ESR decreased to (25.1 ± 8.9) mm/1 hour at 1 week postoperatively, showing significant difference when compared with preoperative value (t=5.935, P lt; 0.01); it decreased to (14.1 ± 4.6) mm/1 hour at 3 months postoperatively. According to Frankel grade, the neurological function was significantly improved at 1 year after operation (χ2=13.689, P=0.003). The average Cobb angle was (17.1 ± 4.5)° at 1 years postoperatively, showing significant difference when compared with preoperative value (t=7.476, P lt; 0.01). Conclusion One-stage posterior debridement, bone graft, and internal fixation has a good cl inical effectiveness for thoracic tuberculosis with less injury and complete focal cleaning, as well as a goodeffectiveness of spinal canal decompression and kyphosis deformity correction.
ObjectiveTo evaluate the feasibility and effectiveness of one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis. MethodsBetween January 2010 and December 2014, 32 cases of lumbosacral spinal tuberculosis (L4-S1) were treated by one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation. There were 20 males and 12 females, aged 17-62 years (mean, 43 years). The disease duration was 12-48 months (mean, 18 months). The involved segments included L5, S1 level in 19 cases and L4, 5 level in 13 cases. The effectiveness was evaluated by Oswestry disability index (ODI) and imaging parameters (lumbar-sacral angle correction and Bridwell classification and CT fusion criteria) after operation. ResultsThe operation was successfully completed in all patients; the average operation time was 180 minutes, and the average intraoperative blood loss was 400 mL. All cases were followed up 12 to 67 months (mean, 15.6 months). At last follow-up, common toxic symptom of tuberculosis disappeared, and no internal fixation failure occurred. Neurological function was recovered to normal in 7 patients with neurological symptoms, and American Spinal Injury Association (ASIA) scale was improved to grade E from grade C (2 cases) and grade D (5 cases) before operation. At 1 year and last follow-up, the ODI scores were significantly improved when compared with preoperative score (P < 0.05), but no significant difference was found between at 1 year and last follow-up (P>0.05). The lumbarsacral angle was significantly increased at 7 days, 1 year and last follow-up when compared with preoperative one (P < 0.05), but there was no significant difference between different time points after operation (P>0.05). The bone graft fusion time was 9-24 months (mean, 12 months). At 1 year after operation and last follow-up, X-ray Bridwill bone fusion rates were 87.50% (28/32) and 93.75% (30/32) respectively, and CT fusion rates were 87.50% (28/32) and 90.63% (29/32) respectively; and there was significant difference in interbody fusion between at 1 year and last follow-up (P < 0.05). Drug resistance was observed in 4 cases; Bridwill gradeⅢand gradeⅣfusion was shown in 3 cases and 1 case after adjusting the anti-tuberculosis scheme after 1 year. ConclusionOne-stage posterior retaining part facet joint in laminectomy and debridement can effectively clear the tuberculose focus, intervertebral bone graft combined with short segment pedicle screw fixation can maintain postoperative spinal reliable stability and get satisfactory bone fusion rate, so it is an effective method for the treatment of lumbosacral tuberculosis.
Objective To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multisegmental spinaltuberculosis.Methods From July 1999 to November 2002, 16 patients with multisegmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T 6T 11 in 11 patients and T 10 -L2 in 5 patients.The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott’s paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. Results All patients were followed up 11 months (6 months-3years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtainedprimary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. Conclusion Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity,and improve its curative ratio and fused ratio of grafted bone.
Objective To evaluate the cl inical significance of the combination of intensified anti-tuberculosis treatment, posterior transpedicular screw system internal fixation, intertransverse bone grafting, and anterior approach focus debridement for the treatment of thoracolumbar tuberculosis. Methods From January 2005 to December 2007, 20 patients with thoracolumbar tuberculosis (T10-L3) were treated. There were 13 males and 7 females aged 21-64 years old (average 44 years old). The course of disease was 3 months to 3 years (average 10 months). The focus involved single vertebrae bodies in 8 cases, two vertebrae bodies in 9 cases, and three vertebrae bodies in 3 cases. The preoperative Cobb angle was 9-35° (average 26.7°). The neurological function was evaluated according to the Frankel grading criterion, there were 2 cases of grade B, 5 of grade C, 7 of grade D, and 6 of grade E. Vertebral body defect index score: 9 cases of 1-2 points, 7 cases of 2-3 points, and 4 cases above 3 points. After receiving the systemic five-drug treatment of anti-tuberculosis for 2-3 weeks, the patients underwent the posterior transpedicular screw system internal fixation and intertransverse bone grafting, and then received tuberculosis focus debridement via anterior approach, nerve decompression, and bone grafting fusion. Results The time of operation averaged 210 minutes and the mean blood loss during operation was 650 mL. Postoperatively, 2 patients had mild belting sensation in their thorax and 2 patients had mild pneumothorax. Their symptoms rel ived 2-3 weeks later without specific treatment. All the patients were followed up for 12-23 months. X-ray films showed that all the patients achieved successful bony fusion 6-18 months after operation, and the Cobb angle was 7-21° (average 15.2°) 12 months after operation without aggravation. The Frankel gradingsystem was used to assess the postoperative neurological function, 1 patient in grade B before operation was improved to grade C after operation, 1 patient in grade B was improved to grade D, 1 patient in grade C was improved to grade D, 4 patients in grade B were improved to grade E, and 7 patients in grade D were improved to grade E. All of the incisions healed and erythrocyte sedimentation rate became normal 2 weeks to 3 months after operation. All the patients showed no obvious abnormity in l iver and kidney function. There was no recurrence of tuberculosis. Conclusion It seems that the systemic drug treatment of antituberculosis before and after operation, the thorough debridement of focus during operation, and the effective and rel iable wayto reconstruct for the spinal stabil ity are the key points for the treatment of spinal tuberculosis.
To evaluate the appl ication value of internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement for the treatment of tuberculosis of lumbosacral vertebral body. Methods From March 2000 to February 2005, 16 cases of spinal tuberculosis in L3-S1 were treated with internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement. Sixteen cases included 11 males and 5 females, and the age was 21-56 years. The locations of spinal tuberculosis were L3 in 4 cases, L4 in 6, L5 in 4, and S1 in 2. The course of disease averaged 13 monthes (range 6 monthes to 6 years). The ESR of all cases was greater than 20 mm/h (average40 mm/h); WBC was normal in 14 cases, and a l ittle high in 2 cases. The X-ray picture showed narrow intervertebral space in 5 cases, compressed body of vertebra in 7 cases, and destroyed 2 consecutive vertebra and its sclerotin was condupl icate in 1 case. All cases were abscess in major psoas muscle. The CT showed destruction of bone, abscess-formation and dead bone in body of vertebra of 16 cases. The abscess were found in vertebral canal in 5 cases and dura mater of spinal cord and spinal nerve root crushed in 2 cases. The MRI showed destruction of bone, abscess-formation and hibateral abscess in major psoas muscle in 11 cases. The abscess were found in vertebral canal and dura mater of spinal cord and spinal nerve root crushed in 6 cases. The therapy of pasid was treated after operation in all the cases. Results Incision healed by first intention in 16 cases; and disruption of wound occurred and heal ing was achieved after symptomatic treatment in 1 case. Sixteen cases were followed up 2-5 years (29 months on average). Among all the cases, anaesthesia in double thigh was found in 3 cases, adynamia of dorsiflexion in foot in 1 case, gatism in 1 case; after 2 weeks the symptoms were vanished. Indirect hernia of fold inguen were found in 1 case after 2 years, and the patient refused operation for age and was no longer followed up. Fuzzy, exsic and acerb in eyes were foundin 6 cases, hearing disturbance were found in 2 cases, and symptoms were vanished after medication adjustment. Low-grade fever and lumbar myalgia were found in 1 case and cured after staying in bed and medication adjustment. All ESR were normal, synostosis of lumbosacral vertebral body was found in 13 cases, kyphosis in 1 case. Conclusion Internal fixation of spinal column by posterior approach and extraperitioneal bilateral focal debridement is safe and available way for the treatment of tuberculosis of lumbosacral vertebral body, it can save the times of operation, shorten period and enhance effect of treatment.
【摘 要】 目的 探讨布鲁杆菌病性脊椎炎有效的外科治疗方法及临床效果。 方法 2002年1月－2010年10月，对78例具有手术指征的胸腰椎布鲁杆菌病性脊椎炎患者采用一期病灶清除联合后路椎弓根内固定治疗。男42例，女36例；年龄24～65岁，平均45岁。病程8～29个月，平均12个月。2个椎体受累70例，3个椎体受累8例。均合并不同程度神经功能损伤。术后随访行疼痛视觉模拟评分（VAS）、神经功能Frankel分级、临床疗效评价以及X线片、MRI影像学观察。 结果 术后78例均获随访，随访时间12～30个月，平均26个月。无窦道形成及复发。术前及术后1、3、6、12个月VAS评分分别为（9.2 ± 0.6）、（2.4 ± 0.3）、（1.0 ± 0.2）、（0.5 ± 0.4）及0分，术后各时间点均较术前显著改善（P lt; 0.05）。术后各时间点神经功能Frankel分级均较术前显著改善，差异均有统计学意义（P lt; 0.05），其中C、D级改善最为显著。临床疗效评价：术后12个月内均无加重患者；随时间推移，改善及无变化患者逐渐转向痊愈，术后12个月改善率和痊愈率分别为100%和91.03%。影像学评价：术前及术后1、3、6、12个月影像学盲测评价指标评分分别为（0.17 ± 0.03）、（4.11 ± 0.09）、（4.68 ± 0.04）、（4.92 ± 0.08）及5分，术后各时间点均较术前显著改善（P lt; 0.05）。 结论 一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎，在解除疼痛、稳定脊柱、恢复神经功能及早期康复方面均有明显优势。
To explore the advantage and indication of combined anterior and posterior surgeries for lumbarsacral junction tuberculosis. Methods Eleven cases of the lumbarsacral junction tuberculosis were treated with combined anterior (radical debridement and autograft) and posterior (instrumentation and fusion) surgeries in one stage between January 2002 and December 2006. There were 9 males and 2 females with the age of 20-56 years old. The courseof disease was 4 to 15 months, 6 months on average. The lessons were located at L5, S1 in 7 patients, at L4,5, S1 in 2 patients and at L5, S2 in 2 patients. The involved vertebral bodies were at 2 segments in 7 patients; and 3 segments in 5 patients. The preoperative kyphosis was 5 to 8° with an average 9°. The sinus was associated in 3 patients, 3 patients had radiculopathy; 4 had paeumonophthisis and 9 had abscess. Results The followed-up period was from 6 months to 3 years, 18 months on average. According to Chen score, among the 11 cases, there were excellent in 9, good in 2. All incisions were healed up primarily. After operation, spinal fusion was achieved in 10 cases within 5 months to 7 months, 6 months on average, and pseudoarthrosis in 1 case was found by the CT examination. The postoperative kyphosis was 0 to 4° with the mean of 2° and the radiculopathy in 3 cases all got nerve function recovery. Conclusion Lumbarsacral junction tuberculosis treated with this surgical technique can achieve a high satisfactory rate with restoring the spinal stabil ity, arresting the disease early, providing early fusion, correcting the kyphosis and preventing progression of kyphosis particularly if lumbosacral spine tuberculosis is associated with sinus or preoperative diagnosis cannot exclude suppurative spondyl itis.
ObjectiveTo explore the effectiveness and safety of treatment of thoracic tuberculosis with thoracoscope supported by digital technology. MethodsBetween June 2010 and February 2012, 11 patients with thoracic tuberculosis were treated and the clinical data were retrospectively analyzed. There were 7 males and 4 females with an average age of 23.6 years (range, 16-47 years) and an average disease duration of 16 months (range, 6-18 months). Two vertebral bodies and one intervertebral space were involved at T6-11. At preoperation, the neurologic function degree was classified as Frankel grade E. Three dimensional reconstruction of thorax and spine and surgical procedure design (including focal clearance, bone grafting, and screw fixation) were done at SUPERIMAGE workstation. Surgery procedures were conducted following the preoperative designs. ResultsThe operative procedures were consistent with preoperative designs. All of these operations were successfully performed. The mean time of operation was 146 minutes (range, 120-180 minutes); the mean blood loss was 120 mL (range, 100-150 mL); the mean indwelling time of closed thoracic drainage was 38 hours (range, 24-48 hours); and the mean hospitalization time was 4.6 days (range, 3-5 days). Eleven patients were followed up 12-25 months (mean, 16 months). No complication of nerve damage, incision pain and infection, or pulmonary infection was observed. Rigid fixation and born fusion were obtained at last follow-up; no obvious change of thoracic vertebral alignment was detected and no internal fixation failure occurred. ConclusionIt is a minimally invasive, effective, and safe method to treat thoracic tuberculosis with thoracoscope supported by digital technology.
Objective To summarize the effect of one-stage anterior debridement of infection in function reconstruction of anterior and middle column for the treatment of thoracolumbar spinal tuberculosis. Methods From January 2001 to January 2007, 65 patients with thoracolumbar spinal tuberculosis were treated with one-stage anterior debridement, decompression, autogenous bone grafts and internal fixation. There were 43 males and 22 females with an average age of 40.2 years (range, 19-64 years), including 18 cases of thoracic tuberculosis (T4-10), 44 cases of thoracolumbar tuberculosis (T11-L2) and 3 cases of lumbar tuberculosis (L3-5). The disease course was 3 months to 10 years (median 10 months). One segment was involved in 7 cases, two segments in 54 cases and three segments in 4 cases. In 14 cases with spinalcord injury, there were 5 cases of grade C and 9 cases of grade D according to Frankel classification. The kyphotic Cobb angle was 20-65° (41° on average). Results The operative time was 120-210 minutes (170 minutes on average), and the blood loss was 300-1 500 mL (600 mL on average). Fifty-eight patients were followed up for 1-6 years (23 months on average). Abscess occurred in 2 cases at 40 days and 3 months, and healed after symptomatic management. The other incisions achieved heal ing by first intention. The X-ray films showed bony fusion 4-12 months (6 months on average) after operation. No tuberculosis recurred. At 12 months after operation, pain disappeared, and there were 7 cases of grade D and 7 cases of grade E according to Frankel classification. The kyphotic Cobb angle was 0-33° (24° on average), showing statistically significant difference (P lt; 0.05) when compared with preoperation. Conclusion Early reconstruction of load-bearing function and stabil ity of anterior and middle column in the treatment of spinal tuberculosis is great significant. The appl ication of one-stage anterior surgery with debridement, decompression, autogenous bone grafts and internal fixation in the operative treatment of thoracolumbar tuberculosis is safe and effective after a rigorous anti-tuberculosis treatment.