[The autologous bundled multi-segment rib graft reconstruction for bone defects after thoracic spinal tuberculosis debridement].
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Oct 01;31(10):1225-1230
Authors: Xu S, Wang G, Yang J, Li J, Duan Y, Xiong Y, Wang Q
Goal: To research the effectiveness of bundled multi-segment autologous rib graft reconstruction for bone defects after thoracic spinal tuberculosis debridement.
Strategies: The anterior debridement, multi-segment autologous rib interbody fusion, anterior or posterior inner fixation had been used for treating the bone defect after thoracic spinal tuberculosis debridement in 36 instances between January 2006 and December 2013. There have been 20 males and 16 females with a mean age of 50.5 years (vary, 21-60 years), and a mean illness period of 6.Eight months (vary, 5-11 months). The thoracic vertebral tuberculosis positioned at T four, 5 in 1 case, T 5, 6 in four instances, T 6, 7 in four instances, T 7, Eight in four instances, T Eight, 9 in 9 instances, T 9, 10 in Eight instances, T 10, 11 in 5 instances, and T 11, 12 in 1 case. Neurological impairment of 34 sufferers was assessed as grade B in 2 instances, grade C in Eight instances, and grade D in 24 instances in line with Frankel classification. The pre- and post-operative erythrocyte sedimentation price (ESR), C reactive protein (CRP), visible analogue scale (VAS) rating, and kyphosis Cobb angle had been evaluated. The fusion price was analysed primarily based on CT three-dimensional reconstruction.
Outcomes: The cross-sectional space of the bundled multi-segment rib graft was 136.Eight-231.2 mm 2 (imply, 197.1 mm 2); the endplate floor space of adjoining higher and decrease vertebral our bodies was 425.Zero-677.6 mm 2 (imply, 550.6 mm 2); and the cross-sectional space of rib graft accounted for 29%-50% (imply, 33.6%) of the endplate floor space. The operation time was 95-160 minutes (imply, 125 minutes) and the intraopeartive blood loss was 280-850 mL (imply, 450 mL). All of the sufferers had been adopted up 2-Eight years (imply, four.four years). The postoperative issues included intercostals neuralgia in 2 instances, pleural effusion in 1 case, and liver operate injury attributable to antituberculosis medicine in 2 instances, who had been all cured after symptomatic remedy. The remaining sufferers had no respiratory issues and wound an infection; and there was no fracture, displacement, absorption of rib help, tuberculosis recurrence, inner fixation loosening, and kyphosis occurred in all sufferers. CT three-dimensional reconstruction confirmed that the fusion price was 86.1 (31/36) at 6 months after operation and was 97.2% (35/36) at 12 months after operation. The ESR, CRP, VAS scores, and kyphosis Cobb angle at three months after operation and final follow-up had been considerably improved when put next with preoperative values ( P<Zero.05), however there was no important distinction between at three months after operation and final follow-up ( P>Zero.05). Neurological deficits had been all improved ultimately follow-up in line with Frankel classificaiton, together with 2 instances with grade B recovered to grade D, Eight instances with grade C to grade D in 1 case and to grade E in 7 instances, 24 instances with grade D all to grade E.
Conclusion: Bundled multi-segment autologous rib graft reconstruction is another technique for lower than 2 discs and vertebral bone defect created by radical debridement for thoracic spinal tuberculosis.
PMID: 29806325 [PubMed – in process]