邓强主任医师辨治胸腰椎结核临床疗效回顾性分析与经验总结  

Retrospective Analysis and Experience of Chief Physician Deng Qiang in Differentiating and Treating Thoracolumbar Tuberculosis

作　　者：马斌祥[1] 屈红[1] 邓强(指导)[1] MA Binxiang;QU Hong;DENG Qiang(Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,China)

机构地区：[1]甘肃省中医院,甘肃兰州730050

出　　处：《西部中医药》2024年第3期16-20,共5页Western Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金地区基金(81860860,82060879);兰州市人才创新创业专项(2017-RC-44);白求恩·脊柱病理性骨折椎体强化治疗专项基金项目(BK-JP2018004);甘肃省自然科学基金(20JR10RA356)。

摘　　要：目的:回顾性分析、总结邓强主任医师中西医结合辨治胸腰椎结核的临床效果及经验。方法:回顾性分析2016年6月1日至2020年9月31日在甘肃省中医院住院的47例胸腰椎结核患者的病历资料,治疗方案:四联抗结核药物(利福平胶囊、异烟肼片、乙胺丁醇胶囊、吡嗪酰胺胶囊)口服+胸腰椎后路病灶清除椎弓根钉内固定+围术期中医药辨证论治,并配合围手术期功能锻炼。观察术后2周及术后1、3、6、12、18个月患者血沉、Cobb后凸角、脊髓神经功能分级(ASIA分级)、视觉模拟量表(visual analogue scale,VAS)评分、临床疗效及并发症发生情况,并通过验案探讨其辨治该病的经验。结果:术后18个月患者血沉、VAS评分分别为(8.45±2.11)mm/h、(1.55±1.31)分,低于术后2周的(48.55±6.14)mm/h、(6.12±1.23)分(P<0.05);Cobb后凸角、ASIA分级术后18个月高于术后2周;术后18个月总有效率为97.9%(46/47),高于术后2周的66.1%(31/47);术后6个月1例患者重体力劳动后出现手术切口尾端崩裂约2 cm,无脓性分泌物流出,给予清创缝合换药后,正常愈合;术后18个月1例患者出现内固定断裂伴发脊柱变形,进行了再次手术。结论:口服四联抗结核药物+胸腰椎后路病灶清除椎弓根钉内固定+围术期补虚培元兼化痰通络,可改善胸腰椎结核患者临床症状、体征及ASIA分级。Objective:To retrospectively analyze and summarize the clinical effect and experience of the combination of Chinese and Western medicine in differentiating and treating thoracolumbar spinal tuberculosis by chief physician Deng Qiang.Methods:Medical records of 47 patients with thoracolumbar spine tuberculosis hospitalized in Gansu Provincial Hospital of Traditional Chinese Medicine from June 1,2016 to September 31,2020 were retrospectively analyzed,they adopted therapeutic regimen:quadruple antituberculosis drugs(rifampicin capsules,isoniazid tablets,ethambutol capsules,pyrazinamide capsules)orally+internal fixation by posterior thoracolumbar debridement with pedicle screws+syndrome differentiation and treatment during perioperative period combined with perioperative functional exercises.To observe blood sedimentation,Cobb angle,spinal cord neurological function classification(ASIA classification),VAS scores,clinical effects and the incidence of the complications two weeks,one month,three,six,twelve and eighteen months after the operation,and to explore chief physician Deng Qiang's experience in differentiating and treating the disease by the proven cases.Results:The patients'blood sedimentation and VAS scores were(8.45±2.11)mm/h and(1.55±1.31)points eighteen months after the operation respectively,lower than(48.55±6.14)mm/h and(6.12±1.23)points two weeks after the surgery(P<0.05);Cobb angle and ASIA classification eighteen months after the operation were higher than these two weeks after the operation;total effective rate eighteen months after the operation was 97.9%(46/47),higher than 66.1%(31/47)two weeks after the operation;one patient suffered caudal chipping of surgical incision of about two cm after doing heavy work without purulent secretion six months after the operation,and it healed normally after debridement,suturing and changing the dressing;eighteen months after the operation,one patient appeared internal fixation fracture accompanied by deformation of the spine,and operated again.Conclusion:Oral

关 键 词：结核 胸腰椎 中西医结合 经验 邓强 

分 类 号：R274.9[医药卫生—中西医结合]