Efficacy analysis of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments with minimum 5-year follow-up.
Efficacy analysis of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments with minimum 5-year follow-up.
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DOI：
10.1038/s41598-021-04138-2
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发表时间：
2022-01-07
影响因子：
4.6
通讯作者：
Wang B
中科院分区：
文献类型：
--
作者：
Zhan Y;Kang X;Gao W;Zhang X;Kong L;Hao D;Wang B
近年来，随着脊柱结核研究的深入，单纯后路手术能更好地矫正脊柱后凸，保持脊柱生理弯曲，手术创伤小，手术并发症少，受到越来越多外科医生的好评。然而，单纯后路手术治疗T4-6节段结核的疗效目前缺乏相关报道。本研究旨在评价一期后路手术治疗T4-6节段胸椎结核的临床研究效果和可行性。67例T4-6节段结核患者接受一期单纯后路手术纳入本研究。根据术前、术后及末次随访时的红细胞沉降率（ESR）、c反应蛋白（CRP）、Oswestry功能指数（ODI）评分、视觉模拟评分（VAS）评分及Cobb角数据，采用统计学方法评价两组患者的临床疗效。所有患者均在随访6-9个月期间完成融合。随访6个月，ESR、CRP均恢复正常。同时，在27例合并神经功能障碍的患者中，末次随访时神经功能完全恢复的有22例（81.48%）（P < 0.05）。后凸Cobb角由术前34.8±10.9°改善至术后9.6±2.8°，末次随访时维持在11.3±3.2°，ODI和VAS评分分别提高77.10%和81.70%。这项为期5年的随访研究表明，采用肋横清创一期后路联合植骨内固定治疗T4-6节段结核可获得较好的临床疗效。后路手术方法既能有效完成清创，取得满意的临床效果，又能很好地矫正后凸畸形并保持。
In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4–6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4–6 segments. 67 patients with tuberculosis in T4–6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4–6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it.
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