复治脊柱结核的治疗方案及疗效的临床研究  

Clinical study on the therapeutic scheme and curative effect of retreating postoperative spinal tuberculosis

作　　者：姚黎明[1] 赵茜[2] 刘丰胜[1] 李卓[1] 董昭良[1] 贾晨光[1] 

机构地区：[1]河北省胸科医院骨科,河北石家庄050041 [2]河北省人民医院急诊科,河北石家庄050051

出　　处：《河北医科大学学报》2016年第5期550-554,共5页Journal of Hebei Medical University

基　　金：河北省科学技术研究与发展计划(1120140287)

摘　　要：目的探讨复治脊柱结核的手术治疗方案及疗效。方法回顾性分析收治的针对不同原因采用个体化治疗的35例复治脊柱结核患者的相关临床资料。再次手术方式：单纯病灶清除、窦道切除术10例,病灶清除植骨融合术5例,病灶清除植骨融合内固定8例,病灶清除植骨融合原内固定物取出7例,病灶清除植骨融合原内固定物取出再次内固定5例。术后联合应用抗结核药物治疗18～24个月,随访观察病灶治愈、植骨融合情况并分别应用视觉模拟量表（Visual Analogue Scale,VAS）评分评估疼痛症状及Oswestry功能障碍指数评分评估脊柱功能改善情况。结果随访时间28～48个月。所有患者均达临床治愈且术后植骨顺利愈合。随访期内未见复发病例。VAS评分由入院后第1天（6.41±2.56）分降至术后第7天（3.20±1.48）分（P〈0.05）;患者终末随访时Oswestry功能障碍指数评分（15.42±7.56）分较术前（65.34±25.48）分明显降低（P〈0.01）。结论多种因素综合作用影响脊柱结核术后复治的疗效。全面系统地评估术前状态、参考既往治疗方案制定个体化的药物及手术应对策略,可显著减轻疼痛并改善功能,是提高脊柱结核的复治疗效的关键。Objective To investigate the therapeutic scheme and curative effect of retreating postoperative spinal tuberculosis.Methods A total of 35 patients with postoperative recurrence of spinal tuberculosis underwent individual treatment,which were studied retrospectively.Individual operation was performed：10cases with debridement and sinus resection,5 with debridement and interbody fusion,8 with debridement,interbody fusion and anterior inernal fixation,7with debridement,interbody fusion and dislodgment of internal fixator,5with one stage debridement,interbody fusion,dislodgment of primary internal fixator,combined anterior or posterior internal fixation. All patients were followed regularly, and treated by antituberculosis chemotherapy for 18～24months.Clinical effect,focus heeling and bone fusion were evaluated at follow-up period.The outcomes were retrospectively analysed by preoperative and postoperative Visual Analogue Scale（VAS）scores and Oswestry Disability Index（ODI）scores.Results The follow-up period were ranged from 28 to 48 months.All cases were recovered,and there had no recurrence.All had good healing of bone graft after operation.After admission the VAS scores was decreased from 6.41±2.56 of first day after admission to 3.20±1.48 at a week after operation（P〈0.05）.There were significent improvements of ODI scores from 65.34±25.48 preoperatively to 15.42±7.56 at the final follow-up（P〈0.01）.ConclusionThe curative effect of retreating postoperative spinal tuberculosis was multifactorially effected by many complicated factors.The adequate preoperative evaluation,individual antituberculosis chemotherapy and operation according to previous therapeutic scheme could improve the pain.The function along with quality of life were key to improving the curative effect.

关 键 词：结核 脊柱 药物疗法 外科手术 

分 类 号：R529.2[医药卫生—内科学]