One-stage Surgical Management for upper Thoracic Tuberculosis by Posterior Pedicule Screw-rods System Fixation,Debridement and Bone Graft

ZHANG Xue-liang; WANG Wen-ji

Abstract：Objective Toinvestigatetheclinicalefficacyofone-stagesurgicalmanagementforupperthoracictuberculosis byposteriorpediculescrew-rodssystemfixation,debridementandbonegraft.Methods Atotalof12patientswithuppertho-racic tuberculosis were treated by one-stage spinal fixation with midline incision,removing front-side focus by rib and transverse resection,grafting surgeries from March 2009 to January 2011. There were 10 males and 2 females;with the age of 9 to 45 years,36. 2 years on average;1 case had segmental lesion at T2~3 ,2 at T3~5 ,6 at T4~6 ,2 at T5~6 and 1 at T6 . The primary symptom of all patients was chest and back pain with varying degrees of neurological dysfunction. The preoperative kyphosis was 15° to 52°,30. 2° on average. There were 2 cases of grade of B,2 cases of grade C and 8 of grade of D in Frankel grading. The average erythrocyte sedimention rate on admission was 71 mm/h,and the average preoperative ESR was 35 mm/h. Results Allpatientswerefollowedupfor6~22months.Therewasonecaseofskinnecrosisandalltheotherwouldhealed.TheERS decrsead to normal range in 1~3 months postoperative. Thoracic kyphosis were significantly improved,the postoperative kypo-sis was 10°~27°,19° on average. Spinal fusion was achieved in 4 to 7 months,5 months on average. There was no recurrence or fixation-related complications at the final follow up. 2 cases of grade B recoverd to grade C,1 of grade C to grade D and an-othertogradeE,8ofgradeDtogradeE.Conclusion Thissurgicaltechniqueisasimpleandlessinvasivewayto.Treating upper thoracic tuberculosis,it is helpful to restore the spinal stability,correct the kyphosis,and the operation is safe and with few complications.