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[Analysis of postoperative recurrence reason and observation of reoperation outcome for spinal tuberculosis].

OBJECTIVE
To analyze the reason of postoperative recurrence of spinal tuberculosis and observe the clinical outcome of these patients in reoperation.


METHODS
From January 2002 to May 2010,27 patients with postoperative recrudescent spinal tuberculosis were treated. There were 15 males and 12 females with an average age of 36.5 years old (ranged, 21 to 65). The risk factors and effect strength associated with postoperative recrudescent spinal tuberculosis were compared by Logistic regression analysis. Individual operation was performed according to the major reason. Re-operative methods including debridment in 5 cases, debridment and sinuses resection in 7 cases, one stage debridement and bone grafting via anterior approach and internal fixation via posterior approach in 8 cases, one stage bone grafting and internal fixation via posterior approach combined with CT-guided percutaneous catheter drainage and local chemotherapy in 2 cases, CT-guided percutaneous catheter drainage and local chemotherapy in 5 cases. Antituberculosis drugs were regularly used in all patients after operation. The ESR, X-ray and 3D-CT were regularly performed to estimate the progress of tuberculosis and condition of bony fusion.


RESULTS
The risk factors associated with postoperative recrudescent spinal tuberculosis were complicated, including no regularly used antituberculosis drugs before and after operation, no early diagnosis and treatment of the postoperative fluidify, malnutrition, no thoroughly debridement during operation and poor spinal stability after operation, according to effect strength to arrange. There was no injury of blood vessel,spinal cord or ureter during reoperation. The follow-up period was from 12 to 36 months with an average of 24 months. Tuberculosis symptoms disappeared after reoperation and no complications such as tuberculosis recurrence, infection of incision, sinuses formation and internal fixation failure were found in the patients. ESR recovered normal in follow-up and bone graft obtained fusion at 8 to 12 months after operation and internal fixation position was normal.


CONCLUSION
The reoperative reasons of spinal tuberculosis are complicated and multifactorial. The diagnosis and treatment are difficult. It is important to analyze the recrudescent reasons thoroughly before operation,emphasize the application of regularly antituberculosis drugs and individual operation, meanwhile, reinforce nourishment and supportive treatment.