The 940th Hospital, China.
Lanzhou University First Affiliated Hospital: Lanzhou University First Hospital, Lanzhou, China.
Acta Orthop Traumatol Turc. 2024 Aug 21;58(4):203-208. doi: 10.5152/j.aott.2024.23209.
This study aimed to evaluate the effectiveness and feasibility of the posterior-only approach for debridement, interbody fusion, and internal fixation in treating upper thoracic tuberculosis. This study retrospectively analysed the clinical and radiographic data of 8 patients diagnosed with upper thoracic tuberculosis. All patients underwent posterior approach debridement, interbody fusion, and internal fixation. We conducted pre- and postoperative assessments of the visual analog scale (VAS), Oswestry disability index (ODI) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA score, and kyphotic Cobb angle. Back pain and lower limb weakness were the most common presenting symptoms. The mean duration of surgery, amount of blood loss, and volume of postoperative drainage were 262.5 ± 43.3 min, 625.0 ± 333.8 mL, and 285.0 ± 118.1 mL, respectively. Patients were followed up for 36 to 48 months. Three months after surgery, there was a significant improvement in VAS and ODI scores, which further improved until the final follow-up. A statistically significant difference was observed between the preoperative and postoperative periods (P < .05). At the final follow-up, lower extremity function had fully returned to normal in all 5 paralyzed patients. The ESR and CRP returned to normal, 18.1 ± 7.3 mm/h and 9.95 ± 5.41 mg/L, respectively, within 3 months postoperatively. There were statistical differences between the preoperative and postoperative periods (P < .05). The average kyphotic correction rate was (71.5 ± 7.3)%, and the average loss of correction angle was (3.5 ± 1.4)°. Intervertebral bone fusion was achieved by all patients within 15 months (mean 8.3 ± 3.2 months) postoperatively. The posterior-only approach seems an effective, safe, and reliable treatment method for upper thoracic tuberculosis, with favourable clinical and radiological outcomes. Level IV, Therapeutic study.
本研究旨在评估后路清创、椎间融合和内固定治疗胸上段结核的有效性和可行性。本研究回顾性分析了 8 例胸上段结核患者的临床和影像学资料。所有患者均采用后路入路清创、椎间融合和内固定。我们对术前和术后视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）评分、红细胞沉降率（ESR）、C 反应蛋白（CRP）、ASIA 评分和后凸 Cobb 角进行了评估。背痛和下肢无力是最常见的表现症状。手术时间、失血量和术后引流量的平均值分别为 262.5 ± 43.3 分钟、625.0 ± 333.8 毫升和 285.0 ± 118.1 毫升。患者随访 36 至 48 个月。术后 3 个月，VAS 和 ODI 评分显著改善，直至最终随访时进一步改善。术前和术后期间观察到统计学差异（P <.05）。在最终随访时，所有 5 例瘫痪患者的下肢功能均完全恢复正常。ESR 和 CRP 术后 3 个月内恢复正常，分别为 18.1 ± 7.3mm/h 和 9.95 ± 5.41mg/L，与术前相比有统计学差异（P <.05）。术后平均后凸矫正率为（71.5 ± 7.3）%，平均矫正角度丢失（3.5 ± 1.4）°。所有患者术后 15 个月（平均 8.3 ± 3.2 个月）均获得椎间骨融合。后路入路似乎是治疗胸上段结核的一种有效、安全、可靠的方法，具有良好的临床和影像学结果。IV 级，治疗性研究。
