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| YANG Xinming,MENG Xianyong,ZHANG Ying.Treatment of the brucellar spondylitis in the thoracic and lumbar vertebrae by surgery[J].Chinese Journal of Spine and Spinal Cord,2012,(7):600-606. |
| Treatment of the brucellar spondylitis in the thoracic and lumbar vertebrae by surgery |
| Received:November 04, 2011 Revised:May 22, 2012 |
| English Keywords:Brucellar spondylitis Thoracic and lumbar vertebrae Focal cleaning Internal fixation Effect |
| Fund:张家口市2010年科学技术与发展指令计划资助项目（编号：1012010D） |
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| English Abstract: |
| 【Abstract】 Objectives: To discuss the methods and clinical effect of treatment of the brucellar spondylitis in the thoracic and lumbar vertebrae by surgery. Methods: From January 2002 to October 2010, 134 cases of brucellar spondylitis were treated by surgery. Of which 56 cases in group A were treated by focal cleaning, bone grafting and fusion, and 78 cases in group B were treated by focal cleaning, bone grafting and fusion combined with posterior pedicle internal fixation. All of the patients were treated by drugs and had no improved symptoms and signs. There was hardly absorbable paravertebral abscess or epidural abscess in the vertebral canal, or destructive intervertebral disc, or inflammatory granulation tissue protruding into the vertebral canal and opressing the spinal cord, cauda eguina or nerve root, or unstable spine by MRI in all the cases. The patients were treated by standard drugs after the operation, assisting hyperbaric oxygen treatment again. VAS score was performed before the operaiton and 3 days, 2 weeks, 3 months and 12 months afer the operation. The cases were followed up at the 3rd, 6th and 12th month after the operation. The data between the two groups and in different period were analyzed by statistics. Results: Operations in the two groups were completed successfully and there was no correlated complication during the operation. Group A was followed up for 12 to 24 months and for 18 months on average. There were 21 cases with bone healing and stable spine, and the healing time was 8 to 11 months, 10 months on average; there were 35 cases with bone disunion, of which 6 cases with unstable spine, 4 cases with pressure ulcer, 3 cases with deep veins of lower limb and 4 cases recurring 12 months after the operation. Group B was followed up for 12 to 30 months and for 26 months on average. All the cases in group B had bone healing and stable spine with no correlated complication, and the healing time was 5 to 10 months, 8 months on average. In 32 cases, the internal nut-locking devices were taken out, and inflammation was not found in the bone tissues by pathologic observation. By comparing the VAS score on each period after the operation with which before the operation, the difference had statistical significance(P<0.05), with more obvious improvement in group B in the early period. The good rate on the 3rd, 6th and 12th month after the operation was 60.71%, 85.71% and 92.85% respectively in group A and 92.30%, 98.71% and 100% respectively in group B. By comparing the good rate on each point-in-time after the operation with which on the former point-in-time in the two groups, the difference had statistical significance(P<0.05). The good rate in group B was much better than that in group A on the same point-in-time after the operation, and the difference had statistical significance(P<0.05). Conclusions: Both two operation methods can clear focus of infection, alleviate or remove the pain, and cure brucellar spondylitis on the base of drug treatment. After focal cleaning, bone grafting and fusion combined with posterior pedicle internal fixation, the spine stabilization and reduction of complications can be realized, which is beneficial for the early rehabilitation of patients and clinical effect improvement. |
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