后路病灶清除钛笼支撑植骨内固定术治疗胸腰椎结核合并后凸畸形.

Objective To investigate the clinical effect of posterior debridement， titanium mesh supporting bone graft and internal fixation in the treatment of thoracolumbar tuberculosis complicated with kyphosis. Methods A total of 38 patients with thoracolumbar tuberculosis complicated with kyphosis were retrospectively analyzed. They were hospitalized in the FirstAffiliated Hospital of Kunming Medical University from June 2016 to June 2019. There were 20 males and 18 females with an average age of （37.9 ±5.6） years. During hospitalization， posterior debridement， titanium mesh supporting bone graft and internal fixation were performed. All patients were followed up for 6-30 months， with an average of （18 ±6.8） months. The operation time， intraoperative blood loss and intraoperative complications were analyzed. VAS score， JOA score， Frankel grade of spinal cord function， Cobb angle， erythrocyte sedimentation rate and bone graft fusion were compared among 1 month before and after operation and the last follow-up. Results The operation time was 150-330 min，with a mean of （287±42.5） min；blood loss was 200-500 mL，with a mean of （393±63.4） mL；no nerve or spinal cord injury occurred during operations. Postoperative abscesswas absorbed， tuberculosis symptoms disappeared without recurrence， an dno incision infection or nonunion occurred. VAS score was （1.30 ±0.57） in the last follow-up， which was significantly lower than that before operation （ ＜0.05） . The JOA score at the last follow-up was （24.80 ±1.67）， which was significantly higher than that before operation （9.35 ±4.44） . According to the Frankel classification of spinal cord function， there were 4 cases of grade E， 18 cases of grade D， 11 cases of grade C， 5 case of grade B and 0 case of grade A. After operation， 17 cases of grade D recovered to grade E， 10 cases of grade C to grade D， and 4 case of grade B to grade C. The average ESR was （36.65 ±13.86） mm/h at admission. The ESR was normal at 4 to 9 months after operation. All the intervertebral bone grafts were fused and the internal fixation was stable from 5 to 12 months after operation. The average time of bone graft fusion was （8.01 ±1.52） months. The Cobb angle at the last follow-up was （8.05±5.20） degrees， which was significantly lower than that of the control group before operation （32.40±19.31） degrees （ ＜0.05） . Conclusion Posterior debridement，titanium mesh supporting bone graft and internal fixation is effective and safe in the treatment of thoracolumbar tuberculosis with kyphosis. [ABSTRACT FROM AUTHOR]