A preliminary study on the surgical timing of spinal tuberculosis / 中国骨伤

OBJECTIVE@#To observe the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery, explore the timing of surgical intervention, and evaluate its influence on surgical safety.@*METHODS@#A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017, including 278 males and 109 females, aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis, 86 cases of thoracic tuberculosis, 76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvementand 90 patients with multiple segmental involvement. Among them, 62 cases presented neurological damage, and preoperative spinal cord neurological function depended on ASIA grade, 5 cases of grade A, 8 cases of grade B, 39 cases of grade C, and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment, the patients were divided into group A (256 cases, receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases, receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender, age, preoperative complicated pulmonary tuberculosis, lesion site, lesion scope, surgical approach, drug resistance and other general clinical characteristics. ESR, CRP, visual analogue scale(VAS), Oswestry Disability Index (ODI), Frankel grade and postoperative complications were observed.@*RESULTS@#All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender, age, preoperative pulmonary tuberculosis, lesion site, lesion range, surgical approach, preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery, with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery (@*CONCLUSION@#After 2-4 weeks of anti tuberculosis treatment before operation, patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle, patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery.

Treatment of tuberculosis of lumbar spine in elderly patients with percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation / 中国骨伤

OBJECTIVE@#To explore the clinical effects and advantages of percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation in the treatment of tuberculosis of lumbar spine in elderly.@*METHODS@#The clinical data of 32 patients with tuberculosis of lumbar spine received percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation from May 2013 to May 2016 were retrospectively analyzed. There were 13 males and 19 females, aged from 62 to 85 years old with an average of 75 years. Lesion segmental Cobb angle was 13° to 21° with an average of (16.52±3.20)°. Tuberculosis focal involved L₁-L₂ of 1 case, L₂-L₃ of 4 cases, L₃-L₄ of 15 cases, L₄-₅ of 10 case, L₅-S₁ of 2 cases. Cobb angle, VAS score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and ASIA grade were compared before and after operation. The stability of the spine and the recurrence of tuberculosis were evaluated.@*RESULTS@#All patients were followed up for 12-36 months with the mean of 24 months. Three patients complicated with giant paravertebral psoas abscess occurred sinus tract in canal orifice of drainage tube after irrigation, and healed in 3 months after operation. Other 29 patients obtained healing of phase I without sinus tract formation. The clinical symptoms of all patients obvious improved at 2 weeks to 3 months after operation and no complications such as severe heart and lung, liver and kidney dyfunction were found. VAS scores and Cobb angles were improved from preoperative(6.77±1.23) points and(16.52±3.20)° to(4.71±0.69) points and (4.24±1.22)° at 1 week after operation. No infection and tuberculosis recurrence were found at follow-up period. ESR and CRP were normal at final follow-up and ASIA grade had obvious improved.@*CONCLUSIONS@#Percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation is a simple, effective and safe method for tuberculosis of lumbar spine in elderly, and is worthy to recommend its clinical use.

Application of cortical bone trajectory screw in elderly patients with lumbar tuberculosis / 中国骨伤

OBJECTIVE@#To explore the clinical effect of cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft for lumbar tuberculosis in elderly.@*METHODS@#The clinical data of 22 patients with lumbar tuberculosis treated by cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft from February 2015 to December 2016 were retrospectively analyzed. There were 13 males and 9 females with an average age of (73.3±7.1) years old. The pre-operative Frankel grading showed that 2 cases were grade B, 5 cases were grade C, 6 were grade D, and 9 were grade E. Pre- and post-operative kyphosis Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate(ESR) and the Frankel grade were analyzed, the conditions of complication, stability of internal plants, graft fusion were observed.@*RESULTS@#All 22 patients were follow-up for 12 to 24 months with an average of (18.7±4.6) years. Two patients with contralateral psoas major muscle abscess enlarged at 3 months after operation and were cured by drainage under the guidance of type-B ultrasonic. Other 20 cases got primary healing without sinus formation and recurrence of spinal tuberculosis. At the final follow-up, the Frankel grading showed that 3 cases was grade C, 5 cases were grade D, and 14 cases were grade E. The Cobb angle, visual analogue scale (VAS), ESR were respectively decreased from preoperative(17.68±3.86)°, (6.95±2.26) points, (47.14±20.85)mm/h to (4.77±2.47)°, (2.18±1.59) points, (16.77±11.42) mm/h at final follow-up. X-ray and CT scan showed bone union for 3 to 8 months after operation, with a mean time of(4.9±1.2) months.@*CONCLUSIONS@#It is effective method to treat lumbar tuberculosis with cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft.

Eearly clinical effects of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical value of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis.</p><p><b>METHODS</b>The clinical data of 18 patients with single-level suppurative spondylitis treated by percutaneous endoscopic focal cleaning and drainage from June 2014 to December 2015 were retrospectively analyzed. There were 11 males and 7 females, aged from 46 to 75 years old with an average of (58.89±9.46) years. According to the patient's diagnosis and drug sensitivity results to anti-infection therapy after operation. All the patients were followed up for 12 to 24 months with an average of(15.50±3.45) months. Disease control status was evaluated by laboratory examination of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) before and after operation. Relief of pain was evaluated using visual analogue scale(VAS). Nerve function was assessed by ASIA classification. Clinical effects were evaluated by Kirkaldy-Willis standard. Spinal stability and recurrence of infection were observed by imaging data.</p><p><b>RESULTS</b>All the operations were successful, and no complication as hematoma, nerve injury, infection, cerebrospinal fluid leakage, sinus formation at the site of tube placement, or mixed infection were found. Postoperative bacteriological report was positive in 12 cases, while 6 cases showed no bacterial growth, and the infection status in 13 cases were confirmed by pathological examination. ESR, CRP, VAS at 2 weeks, 3 months after surgery and at the final follow-up were obviously improved(<0.05). Clinical symptoms were improved significantly at 1 week to 3 months after operation. According to Kirkaldy-Willis standard to evaluate the clinical effect, 14 cases obtained excellent results, 3 good, and 1 fair. Nerve function recovery was based on ASIA grading at the final follow-up. The lost Cobb angles were (1.11±1.18)° on average, with no statistically significant difference before and after operation (>0.05). During the follow-up, no recurrent infection has occurred.</p><p><b>CONCLUSIONS</b>Percutaneous endoscopic focal cleaning and drainage is a minimally invasive, effective and safe surgical method, which serves as a new choice for surgical treatment of suppurative spondylitis.</p>

Application value of Xpert MTB/RIF in diagnosis of spinal tuberculosis and detection of rifampin resistance / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the application value of Xpert MTB/RIF in diagnosis of spinal tuberculosis and detection of rifampin resistance.</p><p><b>METHODS</b>The 109 pus specimens were obtained from patients who were primaryly diagnosed as spinal tuberculosis. All of the pus specimens were detected by acid-fast stain, liquid fast culturing by BACTEC MGIT 960 and Xpert MTB/RIF assay to definite the differences in sensitivity and specificity of mycobacterium tuberculosis among detecting methods. Pus specimens obtained by different methods were deteceded by MTB/RIF test to analyze the self-influence on Xpert MTB/RIF test. The result of liquid fast culturing by BACTEC MGIT 960 was used as the gold standard; and the value of Xpert MTB/RIF assay in detecting rifampin resistance was analyzed.</p><p><b>RESULTS</b>The sensitivity of acid-fast stain, liquid fast culturing by BACTEC MGIT 960 and Xpert MTB/RIF assay were 25.92%, 48.15%, 77.78%, respectively. The sensitivity of pus specimens obtained from open surgery, ultrasound positioning puncture and biopsy the sensitivity were 83.78%, 76.47%, 44.68% respectively deteceded by MTB/RIF test. According to the gold standard of the results of liquid fast culturing by BACTEC MGIT 960 assay, the sensitivity and specificity of Xpert MTB/RIF assay in detecting rifampin resistance were 80%(4/5) and 90.70%(39/43), respectively.</p><p><b>CONCLUSIONS</b>Xpert MTB/RIF assay has higher value in diagnosis of spinal tuberculosi, and also can detect rifampin resistance. The number of mycobacterium tuberculosis in pus specimens has a great influence in the sensitivity of Xpert MTB/RIF assay.</p>

Anterior small-incision focus debridement with posterior internal fixation for the treatment of lumbar spinal tuberculosis / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes and advantages of anterior small-incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal tuberculosis.</p><p><b>METHODS</b>From February 2010 to February 2014, totally 82 patients with lumbar spinal tuberculosis were treated by posterior individual fixation with small-incision focus debridement,including 50 males and 32 females with an average of 50.5 years old. All patients were divided into two groups according to different procedures. Forty-nine patients in group A were treated with anterior small-incision focus debridement with posterior internal fixation through muscle spa ring at stage I ; and 33 patients in group B were treated with focus debridement with posterior internal fixation by extraperitoneal approach at stage I . Postoperative mechanical ventilation time, preoperative and postoperative Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate (ESR) and Frankel grading were observed and compared. Postoperative complications, stability of internal fixation and bone union were compared.</p><p><b>RESULTS</b>All patients were followed-up from 15 to 36 months with an average of 23.7 months. Psoas abscess of three patients in group A and 1 patient in group B on the opposite side increased and were healed by the secondary apocenosis. The other 78 cases were healed at stage I, and no sinus tract formation, incisional hernia, leakage of cerebrospinal and occurrence of spinal tuberculosis were occurred. Fracture healing time ranged from 3 to 7 months with an average of 4.6 months. Postoperative mechanical ventilation time and VAS score in group A was better than group B. There were no statistical differences in Cobb angle, ESR and Frankel grading at the final following-up between two groups.</p><p><b>CONCLUSION</b>Anterior small-incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal according to degree of damage is a safe and effective method.</p>

Percutaneous intervertebral foramina endoscopic lumbar discectomy decompression for elder patients with lumbar spinal stenosis syndrome / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of percutaneous intervertebral foramina endoscopic lumbar discectomy for elder patients with lumbar spinal stenosis syndrome.</p><p><b>METHODS</b>From July 2006 to July 2011, 60 elder patients with lumbar spinal stenosis syndrome were treated with surgical operation, including 32 males and 28 females with an average age of (66.7 +/- 2.5) years old ranging from 72 to 83 years. These patients were divided into the traditional surgery group and percutaneous intervertebral foramina endoscopic discectomy groups (PTED group), 30 cases in each group. The index of the preoperative and postoperative, operative incision visual analogue scale (VAS) of two groups were compared. The Oswestry disability index (ODI) of two groups at 6, 24 months of the follow-up were also evaluated on activity of daily living.</p><p><b>RESULTS</b>The average operative time, the average blood loss, the number of cases using analgesic drug, hospitalization time of PTED group were better than those of the traditional surgery group (P < 0.05). The improvement of incision VAS in PTED group was better than that in the traditional surgery group (P < 0.05). All patients were followed up for 24 months at least. The ODI at 1, 24 month after operation were better than that of preoperative in two group respectively (P < 0.05), but the improvement of PTED group was better than that of the traditional surgery group (P < 0.05).</p><p><b>CONCLUSION</b>PTED has the advantages of smaller incision, less bleeding, less postoperative stay and hospitalization time, tissue trauma and quicker recovery. It is a safe and efficacious minimally invasive surgical technique for elder patients with lumbar spinal stenosis syndrome.</p>

Experiment on articular cartilage defect repaired with autologous cancellous bone or cancellous bone enriching bone marrow stem cell / 中国骨伤

<p><b>OBJECTIVE</b>To compare and evaluate the effect of autologous cancellous bone and cancellous bone enriching bone marrow stem cell for the repairing the defects of articular cartilage, and purpose the experimental basis for clinical application.</p><p><b>METHODS</b>By using the completely random design, 16 adult rabbits were divided into two groups randomly. Autologous cancellous bone and cancellous bone enriching bone marrow stem cells were applied for repairing size-matched, full-thickness articular cartilage defects on the femoral condyle of the knees. The reconstructed tissues were observed by gross, optical and microscopy view and Wakitani score at 12 weeks respectively.</p><p><b>RESULTS</b>In cancellous bone enriching bone marrow stem cells group, articular surface was ivory white and relative evenness, the regenerated tissues integrated well with the surrounding normal cartilage with obscure boundary between them. The thickness of regenerated tissues was two-third of normal cartilage, the Wakitani score was 4.44 +/- 1.41. In autologous cancellous bone group, articular surface was gray and introcession, the regenerated tissues was very thin, the thickness of regenerated tissues was one thirds or one half of normal cartilage, the Wakitani score was 8.93 +/- 1.18. The differences between two groups were significant (P < 0.01).</p><p><b>CONCLUSION</b>Cancellous bone enriching bone marrow stem cells are feasible for repairing of large articular cartilage defects with hyaline cartilage. The repairing ability of autologous cancellous bone is inferior.</p>