一期后路病灶清除自体骨植骨联合局部抗结核药物治疗脊柱结核的临床疗效分析  

Analysis of the clinical efficacy of one-stage posterior autogenous bone grafting combined with local anti-tuberculosis drugs in the treatment of spinal tuberculosis

作　　者：刘颖[1] 赵军[1] 文化[1] 李军 洪浩 衣龙云 丁浩洋 LIU Ying;ZHAO Jun;WEN Hua;LI Jun;HONG Hao;YI Longyun;DING Haoyang(Chongqing Orthopaedic Hospital of traditional Chinese Medicine,Spinal surgery,Chongqing 400012,China)

机构地区：[1]重庆市中医骨科医院脊柱外科,重庆400012

出　　处：《重庆医学》2024年第S01期10-14,共5页Chongqing Medical Journal

基　　金：重庆市渝中区基础研究与前沿探索项目(20210141)。

摘　　要：目的探讨联合局部抗结核药物的一期后路病灶清除自体骨植骨治疗脊柱结核的可行性及中长期临床疗效。方法选取2012年10月至2018年12月该院行一期后路病灶清除自体骨植骨融合治疗的58例脊柱结核患者为研究对象,根据术中是否局部使用抗结核药物分为使用组(26例)和非使用组(32例)。比较两组围手术期指标如手术时间、术中出血量,术后两组C-反应蛋白(CRP)、红细胞沉降率(ESR)、脊髓神经损伤(ASIA分级)、疼痛视觉模拟评分(VAS)、植骨融合率和后凸角度Cobb角等,同时记录两组不良药物反应。结果所有病例术后随访(60.5±5.5)个月。两组平均手术时间,术中出血量,拔引流管时间及全身化疗时间无统计差异(P>0.05)。末次随访时,两组CRP、ESR、VAS评分下降,Cobb角减少及ASIA分级获得明显改善(P<0.05);使用组CRP和ESR在术后3个月时均低于同期非使用组(P<0.05)。使用组无治愈后复发,而非使用组在随访期间共3例(9.38%)患者出现复发(P<0.05)。两组不良药物反应比较差异无统计学意义(P>0.05)。结论联合局部抗结核药物的一期后路病灶清除自体骨植骨治疗脊柱结核的中长期临床疗效满意,可缩短CRP、ESR下降时间,且无明显不良药物反应。Objective To investigate the feasibility and medium-and long-term clinical efficacy of the treatment of spinal tuberculosis with autogenous bone grafting combined with local anti-tuberculosis drugs.Methods Fifty-eight patients with spinal tuberculosis who underwent first-stage posterior debridement autogenous bone graft fusion treatment in this hospital from October 2012 to December 2018 were selected as the study objects,and were divided into the use group(26 cases)and the non-use group(32 cases)according to whether local anti-tuberculosis drugs were used during the operation.Perioperative indexes such as operation time,intraoperative blood loss,postoperative C-reactive protein(CRP),erythrocyte precipitation rate(ESR),spinal cord nerve injury(ASIA scale),visual simulation score(VAS),bone graft fusion rate and kyphotic Angle Cobb Angle were compared between the two groups,and adverse drug reactions were recorded between the two groups.Results All patients were followed up for(60.5±5.5)months.The mean operation time,intraoperative blood loss,drainage tube extraction time and systemic chemotherapy time were not statistically different between the two groups(P>0.05).At the last follow-up,CRP,ESR and VAS scores decreased,Cobb Angle decreased and ASIA grade was significantly improved in both two groups(P<0.05).CRP and ESR in the use group were lower than those in the non-use group at 3 months after operation(P<0.05).There was no recurrence after cure in the treatment group,while relapse occurred in 3 patients(9.38%)in the non-treatment group during the follow-up period(P<0.05).There was no significant difference in adverse drug reactions between the two groups(P>0.05).Conclusion Combined with local anti-tuberculosis drugs,the treatment of spinal tuberculosis with autograft bone graft has satisfactory long-term clinical efficacy,which can shorten the decline time of CRP and ESR,and has no obvious adverse drug reactions.

关 键 词：一期后路 植骨融合 脊柱结核 抗结核药物 

分 类 号：R68[医药卫生—骨科学]