Observation of the Clinical Efficacy of Lesion Clearing, Fusing and Fixation with Single Nail from the Anterior Way for Thoracic Vertebra Tuberculosis_West China Medical Journal

Authors：

 ZHUDing-chuan ¹ ,  GAOFeng ¹ , ZENGJian-cheng ²

1. Department of Orthopedics, Chengdu Tibetan Office Branch Hospital of West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

GAOFeng, Email: gaofeng9191@163.com

Keywords：

Thoracic vertebra tuberculosis; Anterior way; Single nail fixation; Curative effect

DOI：

10.7507/1002-0179.20140008

Video：

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Objective To observe the clinical efficacy of lesion clearing, decompression and fusing, and fixation with single nail from the anterior way for thoracic vertebra tuberculosis. Methods From January 2008 to September 2011, 42 patients with thoracic vertebra tuberculosis were treated in our hospital. There were 28 males and 14 females with the age between 27 and 63 years old, averaging 45. The course of the disease ranged from 4 to 12 months, averaging 8 months. According to the affected parts and segments, there was 1 case of upper thoracic vertebrae involvement, 20 of inner thoracic spine, 21 of lower thoracic vertebrae, 9 of multiple segments, and 2 of multi-level noncontiguous tuberculosis. All patients accepted preoperative normal anti-tuberculosis drugs for 2 to 4 weeks. After confirming that the anti-tuberculosis treatment was effective, we cleared the lesion, fused by decompression at iliac crest bone graft sites and fixed by single nail from the anterior way. Postoperative regular follow-up was carried out. X ray film was used to detect the fusion, paralysis Frankel classification was adopted to evaluate the function recovery of patients, and visual analog pain score (VAS) was used to assess the relief of patients' symptoms. Results All incisions of the patients were healed by the first intention. There was no recurrence in the tuberculosis focus area. Follow-up was done in forty cases for 12 to 34 months, averaging 23 months. X-ray review showed that the bone graft area turned into osseous fusion in all patients with the fusion time ranging from 10 to 16 months, averaging 13 months. No nail bar system loose or fracture occurred. Paralyzed patients Frankel classification showed that there were 2 A-level, 3 B-level, 9 C-level, 25 D-level, and 3 E-level cases before operation. During the last follow-up, there were no A-level, 1 B-level, 5 C-level, 10 D-level, and 26 E-level cases. Local pain VAS score results showed that preoperative point was 7.82±1.03, and the final follow-up point was 0.52±0.31, with a significant difference (P<0.05). Conclusion Lesion clearing, fusion and single nail application from the anterior way is one of the reliable and efficient ways in thoracic vertebra tuberculosis surgery and the results are satisfying.

Citation： ZHUDing-chuan, GAOFeng, ZENGJian-cheng. Observation of the Clinical Efficacy of Lesion Clearing, Fusing and Fixation with Single Nail from the Anterior Way for Thoracic Vertebra Tuberculosis. West China Medical Journal, 2014, 29(1): 26-29. doi: 10.7507/1002-0179.20140008 Copy

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12.	舒敏銳.前路病灶清除椎間植骨融合治療胸腰椎結核[J]. 江西醫藥, 2010, 45(4):319-320.
13.	李壇珠,劉浩. 胸腰椎脊柱結核骨融合技術研究進展[J]. 華西醫學, 2007, 22(3):657-658.
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17.	馮華明, 黃篤, 康照利, 等.前路病灶清除植骨及內固定治療胸腰椎結核療效分析[J].中國醫藥導報, 2011, 8(1):155-159.

1. 張新, 鄭瑞啟, 王明政, 等. 病灶清除植骨融合聯合單釘棒內固定治療胸腰椎結核[J]. 中國臨床實用醫學, 2008, 2(5):95.
2. 朱勇, 趙宏, 邱貴興, 等. 內固定應用于脊柱結核治療的安全性探討[J]. 中華骨科雜志, 2009, 29(7):634-638.
3. Antonio GT, Maria LW, Alfred L, et al. Stenal osteomyelitis caused by mycobacterium tuberculosis[J]. Infect Dis Clin Part, 2004, 12(3):174-177.
4. 陳孝平, 石應康, 邱貴興, 等. 外科學[M]. 2版, 北京:人民衛生出版社, 2011:995.
5. Kotil k, Alan MS, Bilge T. Medical management of Pott disease in the thoracic and lumbar spine:a prospective chnical study[J]. J Neurosurg Spine, 2007, 6(3):222-228.
6. 尹衛軍, 張力. 前路病灶清除椎間植骨融合治療胸椎結核[J].中國醫師雜志, 2009, 11(3):373-375.
7. Garg RK, Somvantion DS. Spinal tuberculosis:a review[J]. Spinal Cord Med, 2011, 34(5):440-454.
8. 葉偉, 李春海, 梁安靖, 等. 脊柱結核一期手術治療的并發癥分析及對策[J]. 中國醫師進修雜志, 2010, 33(17):18-20.
9. Wang Y, Zhang Y, Zhang X, et al. Posterior-only multilevel modified vertebral column resectioll for extremely severe potts kyphotic deformity[J]. Eur Spine J, 2009, 18(10):1436-1441.
10. Ha KY, Chung YG, Ryoo SJ. Adherence and biofilm for mation of staphy locoecns epidermidis and myeobaeterium tubereulusis on various spinal implants[J]. Spine, 2005, 30(1):38-43.
11. Benli IT, Kaya A, Aearoglu E. Anterior instrumentation in tuberculous spondylitis:is it effective and safe?[J]. Clin Orthop Relat Res, 2007(460):108-116.
12. 舒敏銳.前路病灶清除椎間植骨融合治療胸腰椎結核[J]. 江西醫藥, 2010, 45(4):319-320.
13. 李壇珠,劉浩. 胸腰椎脊柱結核骨融合技術研究進展[J]. 華西醫學, 2007, 22(3):657-658.
14. Hirakawa A, Miyamoto K, Masuda T, et al. Surgieal outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis[J]. J Spinal Disoul Tech, 2010, 23(2):133-138.
15. 郭良澤, 毛華晉, 馬力, 等. 前路一期病灶清除植骨內固定治療胸腰椎結核[J].生物骨科材料與臨床研究, 2012, 9(3):41-43.
16. 陳明, 趙勁民, 李兵,等. 前路手術治療伴椎旁巨大膿腫的胸腰椎結核[J].中國脊柱脊髓雜志, 2012, 22(5):433-438.
17. 馮華明, 黃篤, 康照利, 等.前路病灶清除植骨及內固定治療胸腰椎結核療效分析[J].中國醫藥導報, 2011, 8(1):155-159.

West China Medical Journal

Observation of the Clinical Efficacy of Lesion Clearing, Fusing and Fixation with Single Nail from the Anterior Way for Thoracic Vertebra Tuberculosis

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