COMPARISON OF EFFECTIVENESS BETWEEN TWO SURGICAL METHODS IN TREATMENT OF THORACOLUMBAR BRUCELLA SPONDYLITIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YANGXinming ¹ , ZUOXianhong ² , JIAYongli ¹ , CHENGYuefei ³ , ZHANGPeng ⁴ , RENYixing ⁴

1. Department of Orthopaedics, the First Affiliated Hospital of Hebei North University, Zhangjiakou Hebei, 075000, P. R. China;
2. Department of Nursing, Zhangjiakou College, Zhangjiakou Hebei, 075000, P. R. China;
3. Department of Orthopedics, Hebei Wanquan County Hospital, Zhangjiakou Hebei, 075000, P. R. China;
4. Department of Surgery, Graduate School of Hebei North University, Zhangjiakou Hebei, 075000, P. R. China;

Corresponding author：

YANGXinming, Email: yxm1120@sohu.com

Keywords：

Thoracolumbar vertebrae; Brucella spondylitis; Debridement; Posterior internal fixation; Effectiveness comparison

DOI：

10.7507/1002-1892.20140269

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Objective To compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment. Methods A retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed. Results Incision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P < 0.05), and the intraoperative blood lossof group A was significantly lower than that of group B (P < 0.05). All of the cases in 2 groups were followed up 14-38 months, 25 months on average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and there were 1 case of grade C, 11 cases of grade D, and 58 cases of grade E in group B; and difference was not significant (Z=0.168, P=0.682). The grafting bone fusion was observed in both groups. The fusion time was (8.7±0.3) months in group A and (8.6±0.4) months in group B, showing no significant difference (t=0.591, P=0.601) was found. At last follow-up, no loosening or fracture of internal fixation was found. Conclusion Based on regular medicine therapy, the effectiveness of the two methods is satisfactory in the treatment of thoracolumbar brucella spondylitis as long as the operation indications should be controlled strictly.

Citation： YANGXinming, ZUOXianhong, JIAYongli, CHENGYuefei, ZHANGPeng, RENYixing. COMPARISON OF EFFECTIVENESS BETWEEN TWO SURGICAL METHODS IN TREATMENT OF THORACOLUMBAR BRUCELLA SPONDYLITIS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1241-1247. doi: 10.7507/1002-1892.20140269 Copy

1.	章鹏, 杨新明.布鲁杆菌病脊柱炎的治疗进展.实用骨科杂志, 2013, 19(10):908-911.
2.	杨新明, 石蔚, 杜雅坤, 等.布鲁杆菌病性脊椎炎的临床影像学表现及外科治疗.中华骨科杂志, 2008, 28(1):35-40.
3.	买尔旦·买买提, 田娟, 盛伟斌, 等.布鲁杆菌病性脊柱炎的诊断与手术治疗.中华骨科杂志, 2012, 32(4):323-330.
4.	Saltoglu N, Tasova Y, Inal AS, et al.Efficacy of rifampicin plus doxycycline versus rifampicin plus quinolone in thetreatment of brucellosis.Saudi Med J, 2002, 23(8):921-924.
5.	Turgut M, Turgut AT, Kosar U.Spinal brucellosis:Turkish experience based on 452 cases published during the last century.Acta Neurochir (Wien), 2006, 148(10):1033-1044.
6.	杨新明, 张磊, 张瑛, 等.手术治疗胸腰椎布鲁杆菌性脊柱炎.中国脊柱脊髓杂志, 2012, 22(7):600-606.
7.	Katonis P, Tzermiadianos M, Gikas A, et al.Surgical treatment of spinal brucellosis.Clin Orthop Relat Res, 2006, (444):66-72.
8.	Ates O, Cayli SR, Koçak A, et al.Spinal epidural abscess caused by brucellosis.Two case reports.Neurol Med Chir (Tokyo), 2005, 45(1):66-70.
9.	Talu U, Gogus A, Ozturk C, et al.The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis:experience of 127 cases.J Spinal Disord Tech, 2006, 19(8):554-559.
10.	杨新明, 王耀一, 石蔚, 等.布鲁杆菌病性脊椎炎的影像学分型及临床意义.中国骨与关节外科, 2014, 7(2):122-127.
11.	杨新明, 张磊, 张瑛, 等.一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎.中国修复重建外科杂志, 2012, 26(3):266-271.
12.	Sözen S, Üstün C, Altinsoy HB.Psoas abscess secondary to Brucellosis.Bakirköy Tip Dergisi, 2011, 7(2):79-81.
13.	杨卫良, 徐佳元.36例布鲁氏杆菌性脊柱炎的诊断及手术治疗.中国矫形外科杂志, 2011, 19(17):1438-1441.
14.	张宇, 祁全, 沈洪涛, 等.布鲁杆菌病脊柱炎的外科治疗.临床骨科杂志, 2012, 15(2):121-124.
15.	杨新明, 张磊, 刘肃, 等.脊柱疾病.北京:科学技术文献出版社, 2011:271-275.
16.	Passias PG, Ma Y, Chiu YL, et al.Comparative safety of simultaneous and sataged anterior and posterior spinal surgery.Spine (Phila Pa 1976), 2012, 37(3):247-255.
17.	Yang XM, Shi W, Meng XY, et al.The assessment of the clinical effect of the drug compatibility and course of treatment to the Brucellar spondyliti.Scientific Research, 2013, 4(1):92-99.
18.	Wang Z, Ge Z, Jin W, et al.Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae.Spine J, 2007, 7(6):671-681.
19.	Bouaziz MC, Bougamra I, Kaffel D, et al.Noncontiguous multifocal spondylitis:an exceptional presentation of spinal brucellosis.Tunis Med, 2010, 88(4):280-284.

1. 章鹏, 杨新明.布鲁杆菌病脊柱炎的治疗进展.实用骨科杂志, 2013, 19(10):908-911.
2. 杨新明, 石蔚, 杜雅坤, 等.布鲁杆菌病性脊椎炎的临床影像学表现及外科治疗.中华骨科杂志, 2008, 28(1):35-40.
3. 买尔旦·买买提, 田娟, 盛伟斌, 等.布鲁杆菌病性脊柱炎的诊断与手术治疗.中华骨科杂志, 2012, 32(4):323-330.
4. Saltoglu N, Tasova Y, Inal AS, et al.Efficacy of rifampicin plus doxycycline versus rifampicin plus quinolone in thetreatment of brucellosis.Saudi Med J, 2002, 23(8):921-924.
5. Turgut M, Turgut AT, Kosar U.Spinal brucellosis:Turkish experience based on 452 cases published during the last century.Acta Neurochir (Wien), 2006, 148(10):1033-1044.
6. 杨新明, 张磊, 张瑛, 等.手术治疗胸腰椎布鲁杆菌性脊柱炎.中国脊柱脊髓杂志, 2012, 22(7):600-606.
7. Katonis P, Tzermiadianos M, Gikas A, et al.Surgical treatment of spinal brucellosis.Clin Orthop Relat Res, 2006, (444):66-72.
8. Ates O, Cayli SR, Koçak A, et al.Spinal epidural abscess caused by brucellosis.Two case reports.Neurol Med Chir (Tokyo), 2005, 45(1):66-70.
9. Talu U, Gogus A, Ozturk C, et al.The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis:experience of 127 cases.J Spinal Disord Tech, 2006, 19(8):554-559.
10. 杨新明, 王耀一, 石蔚, 等.布鲁杆菌病性脊椎炎的影像学分型及临床意义.中国骨与关节外科, 2014, 7(2):122-127.
11. 杨新明, 张磊, 张瑛, 等.一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎.中国修复重建外科杂志, 2012, 26(3):266-271.
12. Sözen S, Üstün C, Altinsoy HB.Psoas abscess secondary to Brucellosis.Bakirköy Tip Dergisi, 2011, 7(2):79-81.
13. 杨卫良, 徐佳元.36例布鲁氏杆菌性脊柱炎的诊断及手术治疗.中国矫形外科杂志, 2011, 19(17):1438-1441.
14. 张宇, 祁全, 沈洪涛, 等.布鲁杆菌病脊柱炎的外科治疗.临床骨科杂志, 2012, 15(2):121-124.
15. 杨新明, 张磊, 刘肃, 等.脊柱疾病.北京:科学技术文献出版社, 2011:271-275.
16. Passias PG, Ma Y, Chiu YL, et al.Comparative safety of simultaneous and sataged anterior and posterior spinal surgery.Spine (Phila Pa 1976), 2012, 37(3):247-255.
17. Yang XM, Shi W, Meng XY, et al.The assessment of the clinical effect of the drug compatibility and course of treatment to the Brucellar spondyliti.Scientific Research, 2013, 4(1):92-99.
18. Wang Z, Ge Z, Jin W, et al.Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae.Spine J, 2007, 7(6):671-681.
19. Bouaziz MC, Bougamra I, Kaffel D, et al.Noncontiguous multifocal spondylitis:an exceptional presentation of spinal brucellosis.Tunis Med, 2010, 88(4):280-284.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF EFFECTIVENESS BETWEEN TWO SURGICAL METHODS IN TREATMENT OF THORACOLUMBAR BRUCELLA SPONDYLITIS

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