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.
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.
Objective To investigate the effectiveness and feasibil ity of modified single-stage transpedicular decompression, debridement, and posterior instrumentation in treatment of thoracic tuberculosis. Methods Between January 2005 and December 2009, 22 cases of thoracic tuberculosis were treated with modified single-stage transpedicular decompression, debridement, and posterior instrumentation. There were 12 males and 10 females with an average age of 39.4 years (range, 22-52 years). The mean disease duration was 1.2 years (range, 3 months to 10 years). The involved vertebral bodies were T5-12, including 2 segments in 17 cases and 3 segments in 5 cases. The kyphosis Cobb angle was (31.2 ± 14.5)° before operation. According to Frankel score system for neurological deficits, 2 cases were classified as grade A, 1 case as grade B, 8 cases as grade C, 5 cases as grade D, 1 case as grade E, and 5 cases had no neurological deficits before operation. Results All incisions healed by first intention. All patients were followed up 22.2 months on average (range, 12-65 months). Pain in low back was rel ieved in varying degrees 2 weeks after operation. Fusion was achieved in the bone implant area at 3 months after operation. According to Frankel score system, 1 case was rated as grade B, 2 cases as grade C, 4 cases as grade D, 7 cases as grade E, and 8 cases had no neurological deficits at last follow-up. The kyphosis Cobb angle was (16.2 ± 3.6)°, showing significant difference when compared with the value before operation (t=5.952, P=0.001). No loosening, emersion, breakage of internal fixation or pneumothorax occurred 1 year after operation. Conclusion Single-stage transpedicular decompression and posterior instrumentation is an effective and safe method in treatment of thoracic tuberculosis.
Mycobacterium tuberculosis is the causative agent of human tuberculosis. Through the genotyping of Mycobacterium tuberculosis, we can find the epidemic situation and characteristics of tuberculosis in time, analyze the transmission chain between patients in different jurisdictions, and formulate effective intervention measures in time, to provide a strong basis for clinical diagnosis and treatment. At present, several genotyping techniques for Mycobacterium tuberculosis have their advantages and disadvantages in application. This article reviews the genotyping technology, population genetics and genotyping naming rules of Mycobacterium tuberculosis.
Objective To review the diagnosis and treatment of tuberculosis infection after total knee arthro-plasty (TKA). Methods The recent literature concerning the diagnosis and treatment of tuberculosis infection after TKA were extensively reviewed and summarized. Results The diagnosis of tuberculosis infection after TKA is difficult. It should be combined with the patient’s medical history, symptoms, signs, blood examinations, and imaging examinations, among which the bacterial culture and histopathological examination are the gold standard of diagnosis. Treatment strategy is combined with the drug treatment and a variety of surgical procedures that depends on the clinical situation. Conclusion At present, there is no guideline for the diagnosis and treatment of tuberculosis infection after TKA, it still needs further study and improvement.
Objective To assess the effect of astragaulus membranaceus in the treatment of pulmonary tuberculosis. Methods Through applying the methods provided by the Cochrane Collaboration, the randomized controlled trials (RCTs) or quasi-RCTs of astragaulus membranaceus in the treatment of pulmonary tuberculosis were searched in The Cochrane Library (Issue 3, 2010), CNKI (1991 to May 2010), VIP (1989 to May 2010), EMbase (1981 to May 2010), and PubMed (1981 to May 2010). Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross checked then. The RevMan 5.0 software was used to conduct meta-analyses. Results Twelve RCTs involving 1 054 patients were included. All trials were tested in the mainland China. The results of meta-analyses showed that: a) The astragaulus membranaceus could assist the conventional drug to cure pulmonary tuberculosis, promote sputum negative conversion, focal absorption and cavity reduction in lung; b) The astragaulus membranaceus could reduce the adverse reactions of the conventional drug; c) The astragaulus membranaceus combined with the conventional drug could improve the patients’ symptoms and signs; and d) The astragaulus membranaceus combined with the conventional drug could reduce the bacterial relapse rates in follow-up after treatment. Conclusion The current evidence shows that the astragaulus membranaceus has some effects and is relatively safe to treat pulmonary tuberculosis. However, it is far from enough to recommend astragaulus membranaceus as a conventional adjuvant therapy for pulmonary tuberculosis because of no sufficient evidence obtained from this study for its small sample and low methodology quality. Therefore, more double-blind multi-center RCTs with high quality, large sample, and adequate follow up are required for further verification.
Objective To study the cl inical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. Methods From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were compl icated with neural symptom of the lower l imbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were compl icated with il iac abscess, 3 cases with psoas abscess, 3 cases with sacroil iac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogeneous il iac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogeneous il iac bone fragment grafting, and anterior focus debridement was performed. Results The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroil iac joint tuberculosis achieved sacroil iac joint fusion. For those 7 patients with combinations of the neural symptomof the lower l imbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P lt; 0.05). Conclusion The modified Galveston technology is helpful to reconstruct the stabil ity of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.
Objective To assess the rationale for including rifampicin150/isoniazid75/ethambuto/275mg fixed dose, combination oral tablets/3-FDC R150H75E275/ in the WHO Model List of Essential Medicines (WHO EML) for treatment of category II tuberculosis (TB II) and to provide evidence for the updating of national guidelines. Methods We searched Chinese Biomedical Database (CBM, 1978 to 2006), The Cochrane Library, Issue 4, 2006, the Database of Abstracts of Reviews of Effects (1994 to 2006, the Centre for Reviews and Dissemination website), MEDLINE (1950 to 2006), EMBASE (1974 to 2006), BIOSIS Previews (1997 to 2006), websites for grey literature and the references of studies. We applied inclusion and exclusion criteria in assessing the studies we found and eligible studies were graded following an assessment of their quality. Results Thirty-six randomized controlled trials, 4 controlled clinical trials, 11 descriptive studies and 5 WHO/national guidelines were included. Rifampicin (R), isoniazid (H) and ethambutol (E) were used in the ccontinuation phase (CP) of TB II in guidelines of WHO and high tuberculosis (TB) burden countries, but the course of treatment and dosage regimens varied. R, H and E were also widely used in conditions of pulmonary tuberculosis (PTB), extrapulmonary tuberculosis (EPTB) and pulmonary diseases caused by nontuberculous mycobacteria (NTM).Conclusions It is recommended that FDC RHE be included in WHO EML for the treatment of TB II.The suggested dosage ratio of RHE is 1:1:2, which needs to be adjusted based on more solid clinical evidence. High quality clinical studies and systematic reviews on the effectiveness, safety, economics and applicability of WHO and national guidelines and their outcomes in high TB burden countries are needed to guide their updating, promote rational resource allocation and improve cost effectiveness. Alternative drugs or drug combinations with good profile of effectiveness, safety, economics, and applicability for the prevention and treatment of drug-resistant tuberculosis are also needed to be developed.
ObjectiveTo explore the effectiveness of intertransverse bone graft after debridement and fusion combined with posterior instrumentation in patients with single segmental thoracic tuberculosis. MethodsBetween March 2014 and May 2015, 17 cases of thoracic tuberculosis were treated by the surgery of intertransverse bone graft after debridement and fusion combined with posterior instrumentation. There were 10 males and 7 females with an average age of 48.5 years (range, 18-70 years), and with a mean disease duration of 4 months (range, 1-9 months). The affected segments included T4, 5 in 2 cases, T6, 7 in 5 cases, T7, 8 in 3 cases, T9, 10 in 2 cases, T10, 11 in 4 cases, and T11, 12 in 1 case. The operation time, intraoperative blood loss, and hospitalization time were recorded. Postoperative plain radiography was taken to assess the decompression and internal fixation, and the fusion effect was evaluated by X-ray or CT examination. The erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS), Oswestry disability index (ODI), and Kyphosis angle were recorded and compared; the nerve function was evaluated by American Spinal Injury Association (ASIA). ResultsThe mean operation time, intraoperative blood loss, and hospitalization time were 184 minutes (range, 165-220 minutes), 231 mL (range, 150-800 mL), and 18 days (range, 12-26 days) respectively. No complication of hematoma or wound dehiscence was found. All patients were followed up 17.9 months on average (range, 9-22 months). No bone graft failure, internal fixation broken, pleural effusion, cerebrospinal fluid leakage, wound infection, fistula formation, and other complications occurred. Satisfactory intervertebral fusion was obtained in all patients at 3-8 months (mean, 5.3 months) after surgery. The ESR, CRP, VAS score, ODI score, and Kyphosis angle were significantly improved at immediate after operation and last follow-up when compared with preoperative ones (P < 0.05), and the ESR, CRP, VAS score and ODI score at last follow-up were significantly better than those at immediate after operation (P < 0.05). At last follow-up, the nerve function was recovered to ASIA grade E from grade C (1 case) and grade D (6 cases). ConclusionIntertransverse bone graft is a reliable, safe, and effective way of bone graft applied to the single segmental thoracic spinal tuberculosis.
ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.