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.

Comparative analysis of binding multi-fold rib graft, iliac bone graft and titanium mesh graft during surgery of tuberculosis of thoracic vertebra / 中国骨伤

OBJECTIVE@#To compare the clinical effects of three different methods of binding multi-fold rib graft, iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process.@*METHODS@#A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients, after thoroughly remove the necrotic tissue of tuberculosis, three different bone grafts were used respectively including iliac bone graft (36 cases, group A), binding multi-fold rib graft (35 cases, group B), titanium mesh bone graft (36 cases, group C). Perioperative indexes, the time required for bone graft during operation, intraoperation blood loss, the loss rate of the anterior edge of the lesion, Cobb angle, postoperative bone graft fusion time, spinal nerve recovery and Oswestry Disability Index were compared among three groups.@*RESULTS@#All the patients were followed up for 13 to 24 months, and the operation time required for bone graft was (23.2±4.1) min in group A, (23.8± 4.4)min in group B, and (25.5±4.2) min in group C, with no statistically significant difference among three groups (@*CONCLUSION@#The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft, iliac bone graft and titanium mesh graft, but binding multi-fold rib graft can effectively avoid iliac bone donor complications, and is an effective alternative to iliac bone graft, which is worth popularizing.

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>