114例脊柱结核患者的临床特征分析  

Analysis of clinical characteristics of 114 cases of spinal tuberculosis

作　　者：王瑞阳 茹能[1] 向清华 WANG Ruiyang;RU Neng;XIANG Qinghua(Orthopedics Department,the People's Hospital of China Three Gorges University,Yichang 443099,China)

机构地区：[1]三峡大学人民医院骨科,湖北宜昌443099

出　　处：《临床医学研究与实践》2023年第14期64-67,共4页Clinical Research and Practice

摘　　要：目的探讨脊柱结核(STB)患者的临床特征,以提高临床对STB的诊断及治疗。方法回顾性研究分析2018年1月至2022年11月就诊于三峡大学人民医院的114例STB住院患者的临床资料,包括人口学特征、临床表现、实验室检查、影像学检查以及治疗方式。结果纳入的114例STB患者中,发病年龄段以>60~80岁人数最多,以农村居民为主。多数患者以局部疼痛为主要症状,少数患者出现低热、盗汗、乏力等结核中毒症状。STB常合并循环系统疾病,以高血压为主。实验室检查以C反应蛋白(CRP)、红细胞沉降率(ESR)升高最多见。磁共振成像(MRI)检查显示病变最常累及腰椎,且以腰4椎体为主,病变通常累及2个及以上椎体。治疗中,单纯抗结核药物治疗58例,药物加外科手术治疗56例,手术以后路固定、病灶清除术最常见,术中植骨方式主要为取自体髂骨植骨。结论STB具有普遍易感性,其病变多累及腰椎,中老年患者发病率较高,疼痛为其主要临床表现;实验室检查可见CRP、ESR升高,白蛋白减低;MRI对于STB诊断尤为重要;抗结核治疗是最为重要的治疗方式,手术治疗对治愈结核病变、重建脊柱稳定性、恢复脊髓的神经功能等起重要作用,手术治疗以后入路固定、病灶清除术为主,术中植骨主要为自体髂骨植骨。Objective To investigate the clinical characteristics of patients with spinal tuberculosis(STB),in order to improve the clinical diagnosis and treatment of STB.Methods A retrospective study was conducted to analyze the clinical data of 114 in patients with STB admitted in the People's Hospital of China Three Gorges University from January 2018 to November 2022,including demographic characteristics,clinical manifestations,laboratory examinations,imaging examinations and treatment methods.Results Among the 114 patients with STB,most of them were aged>60-80 years old,and most of them were rural residents.Local pain was the main symptom in most patients,while low fever,night sweat,fatigue and other symptoms of tuberculosis poisoning appeared in a few patients.STB was often associated with circulatory diseases,mainly hypertension.Elevated C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were the most common in laboratory tests.Magnetic resonance imaging(MRI)showed that the lesions most frequently involved the lumbar spine,mainly the L4 vertebrae,and the lesions usually involved two or more vertebrae.In the treatment,58 cases were treated with anti-tuberculous drugs alone,and 56 cases were treated with drugs and surgery.Postoperative fixation and clearance of focal lesion were the most common,and the main method of intraoperative bone grafting was autologous iliac bone grafting.Conclusion STB has a common susceptibility,and its lesions mostly involve the lumbar spine.The incidence of STB is high in middle-aged and elderly patients,and pain is the main clinical manifestation.Laboratory tests showed increased CRP,ESR and decreased albumin.MRI is particularly important for the diagnosis of STB.Anti-tuberculosis treatment is the most important treatment mode.Surgical treatment plays an important role in curing tuberculosis,rebuilding spinal stability and restoring spinal cord nerve function.The main surgical treatment is postoperative fixation and clearance of focal lesion,and the main intraoperative bone graf

关 键 词：脊柱结核 临床特征 诊断 治疗 

分 类 号：R52[医药卫生—内科学]