| Objective To investigate the efficacy and strategy of surgical treatment of spinal tuberculosis combined with osteoporosis. Methods A total of 102 patients with spinal tuberculosis complicated with osteoporosis admitted to the 309th hospital of PLA from January 2012 to February 2015 were selected and divided into two groups by stratified random grouping: observation group (n = 51) and control group (n = 51). Age and gender were comparable in the two groups. Surgical procedures depended on the individual lesion and pathological changes including debridement and bony grafting with instrumentation fixation. The postoperative anti-tuberculosis drug therapy lasted for 18 months. At the same time patients in group A received calcium supplements, calcitriol, and bisphosphonate anti-osteoporosis treatment. Bone mineral density (BMD), bone metabolism index, pain visual score, and surgical effect were observed in group A and B. Results After 3 years of follow-up, BMD of the neck of femur, Ward triangular region, and Troch of femur in the observation group were (0.88 ± 0.15) g/cm2, (0.73 ± 0.11) g/cm2, (0.78 ± 0.10) g/cm2, higher than those in the control group (0.71 ± 0.14) g/cm2, (0.59 ± 0.13) g/cm2, (0.61 ± 0.13) g/cm2, respectively. The difference was statistically significant (t = 3.91, 3.58, 3.80, respectively, P <0.01). Serum ALP, c-terminal peptide (CTX) cross-linked with type I collagen, and osteocalcin (OC) in the observation group at the last follow-up were (16.06 ± 8.05) ng/mL, (0.22 ± 0.08) ng/mL, (6.42 ± 1.03) ng/mL, respectively. They were (18.10 ±8.55) ng/mL, (0.52± 0.13) ng/mL, and (7.43 ± 1.52) ng/mL at the last follow-up in the control group, respectively. The differences between the two groups were statistically significant (t =–6.54, –5.47, –3.47, respectively, P<0.01). No internal fixation failure happened in group A. Screw broken in 1 case, loosened in 3 cases, and pulled out in 2 cases in group B. The postoperative local convex Cobb angles were (10.93±6.38)° in group A, and were (10.77 ± 7.12)° in group B. No significant statistical difference was found (t = 0.37, P>0.05). At the last follow-up, the local convex Cobb angles in group A were (11.05 ± 6.17)°, and were (14.08 ± 8.24)° in group B. The difference was statistically significant (t = 3.13, P﹤0.05). X-ray or CT showed that all bone grafts were fused. Conclusion Calcium supplements, calcitriol, and bisphosphonate anti-osteoporosis drug therapy can improve bone mass in patients with spinal tuberculosis combined with osteoporosis, decrease serum ALP content, and increase serum BGP content, which can improve the operative efficacy. |