脊柱结核病理骨折误诊误治因素分析及治疗措施OA

Objective To explore the perioperative management of pathological fractures in spinal tuberculosis patients undergoing vertebral augmentation,and to provide clinical data for the differential diagnosis of spinal tuberculosis.Methods A retrospective analysis was conducted on the clinical data of 30 spinal tuberculosis patients who underwent vertebral augmenta-tion from April 2017 to May 2022.According to the treatment methods,the patients were divided into three groups:Group A(posterior spinal approach with bone cement mass removal,decompression,and bone graft fusion),Group B(posterior spinal decompression and bone graft fusion),and Group C(conservative treatment).Group A included 10 patients(6 males and 4 fe-males)with an average age of(68.50±6.81)years.Group B included 12 patients(8 males and 4 females)with an average age of(67.92±5.86)years.Group C included 8 patients(4 males and 4 females)with an average age of(65.00±7.09)years.All patients received anti-tuberculosis drug treatment for 18 to 24 months.The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),tuberculosis infection T-cell spot test(T-SPOT.TB),visual analogue scale(VAS)for pain,American Spinal Injury Association(ASIA)neurological function classification,and modified Barthel index(MBI)for assessing activities of dai-ly living were observed and compared among the three groups.Results All 30 patients were followed up at 3 and 12 months postoperatively.Among them,27 patients showed elevated ESR and CRP during the preoperative period,and tested positive for T-SPOT.TB;The remaining 3 patients had normal ESR and CRP levels and negative T-SPOT.TB results.In Group A,the VAS decreased from 7.05±1.09 before treatment to 1.85±0.81 at 12 months postoperatively,with a statistically significant difference(P＜0.05).In Group B,the preoperative VAS was 7.67±1.26,which decreased to 2.13±0.74 at 12 months postoperatively,showing a statistically significant difference(P＜0.05).In Group C,the VAS score decreased from 8.56±1.21 before treatment to 3.06±1.23 at 12 months after treatment,with a statistically significant difference(P＜0.05).The ESR and CRP levels of the three groups all returned to the normal range at 3 and 12 months postoperatively,which were significantly different from those before the operation(P＜0.05).At 12 months postoperatively,26 patients achieved complete recovery of ASIA neurological function,and 4 patients achieved partial recovery.The MBI scores of the three groups at 12 months after treatment were signifi-cantly improved compared with those before treatment(P＜0.05).Additionally,at 3 and 12 months after treatment,the MBI scores of Group A and Group B were superior to those of Group C,with statistically significant differences(P＜0.05).Conclu-sion Vertebral wedge deformation is not an exclusive indicator of primary osteoporotic fractures.Clinical details should be thor-oughly analyzed,and attention should be paid to the imaging changes of the soft tissues around the vertebral body and inflam-matory changes.Before vertebral augmentation,routine ESR,CRP tests,and enzyme-linked immunospot assays(T-SPOT.TB)are recommended.For spinal tuberculosis cases that have already undergone vertebral augmentation,individualized surgical treatment plans should be adopted.