微创穿刺引流联合局部化疗治疗胸腰椎结核  

Minimally invasive puncture and drainage combined with local chemotherapy for thoracolumbar tuberculosis

作　　者：李天清 雷伟 马田成 吴子祥 张扬 马真胜 LI Tian-qing;LEI Wei;MA Tian-cheng;WU Zi-xiang;ZHANG Yang;MA Zhen-sheng(Dept of Orthopaedics,the First Affiliated Hospital of Air Force Medical University of CPLA,Xi′an,Shaanxi 710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院骨科,陕西西安710032

出　　处：《临床骨科杂志》2023年第5期614-619,共6页Journal of Clinical Orthopaedics

摘　　要：目的探讨微创穿刺引流联合局部化疗治疗胸腰椎结核的临床疗效。方法采用微创穿刺引流联合局部化疗治疗110例胸腰椎结核患者。记录红细胞沉降率(ESR)、C-反应蛋白(CRP)、ODI、疼痛VAS评分、后凸Cobb角、并发症发生情况以及脊柱结核的临床治愈率。结果患者均获得随访,时间16个月~9年。2例因注药后出现下肢神经症状行开放手术治疗。ESR、CRP、ODI、疼痛VAS评分:术后、末次随访均随时间增加逐步降低(P<0.05)。后凸Cobb角:末次随访均较术前、术后明显减小(P<0.05);术后与术前比较差异无统计学意义(P>0.05)。除1例局部注药7 d后出现椎管内脓液增多和药物聚集导致下肢截瘫、Frankel评级由术前E级降为A级外,其余109例患者末次随访时结核全身症状及局部疼痛均消失。脊柱结核临床治愈率:109例为优,1例为差,优良率为99.1%。结论微创穿刺引流联合局部化疗治疗胸腰椎结核具有创伤小、并发症少、结核临床治愈率高、可操作性高等优势,尤其适用于无神经损害及胸腰椎明显失稳的胸腰椎结核患者。Objective To investigate the clinical effect of minimally invasive puncture and drainage combined with local chemotherapy on thoracolumbar tuberculosis.Methods The 110 patients with thoracolumbar tuberculoses were treated with minimally invasive puncture and drainage combined with local chemotherapy.Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),Oswestry disability index(ODI),pain visual analogue score(VAS),kyphotic Cobb angle,incidence condition of complications,and clinical cure rate of spinal tuberculosis were recorded.Results All patients were followed up from 16 months to 9 years.Open operation was performed in 2 cases due to neurological symptoms of lower extremity after drug injection.ESR,CRP,ODI and pain VAS:they were all decreased gradually with the prolonging of time after surgery and at the last follow-up(P<0.05).The kyphotic Cobb angles:at the last follow-up,they were significantly decreased than the pre-and post-operation(P<0.05);there was no significant difference between the postoperation and preoperation(P>0.05).Except for one case who had lower limb paraplegia caused by increased intraspinal pus and drug accumulation after 7 d of local injection,and Frankel grade was decreased from grade E to A,the systemic symptoms and local pain of tuberculosis disappeared in the orther 109 patients at the last follow-up.The clinical cure rate of spinal tuberculosis:109 cases were excellent,1 case was poor,and the excellent-good rate was 99.1%.Conclusions In the treatment of thoracolumbar tuberculosis,minimally invasive puncture and drainage combined with local chemotherapy have the advantages of less trauma,fewer complications,high clinical cure rate of tuberculosis and high operability,especially for thoracolumbar tuberculosis patients without nerve damage and obvious instability of thoracolumbar vertebrae.

关 键 词：脊柱结核 微创穿刺 引流 局部化疗 

分 类 号：R529.2[医药卫生—内科学] R687.3[医药卫生—临床医学] R452