12例非结核分枝杆菌性脊柱炎手术治疗患者临床特征及治疗转归  

Clinical characteristics and surgical outcomes of 12 cases of non-tuberculous mycobacterial spondylitis

作　　者：范俊[1] 王恒 兰汀隆[1] 董伟杰[1] 唐恺[1] 李元[1] 严广璇 徐尚胜 康志刚 秦世炳[1] Fan Jun;Wang Heng;Lan Tinglong;Dong Weijie;Tang Kai;Li Yuan;Yan Guangxuan;Xu Shangsheng;Kang Zhigang;Qin Shibing(Department of Orthopaedics,Beijing Chest Hospital,Capital Medical University/Beijing Bone and Joint Tuberculosis Treatment Center,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院骨科/北京骨和关节结核治疗中心,北京101149

出　　处：《中国防痨杂志》2025年第1期87-95,共9页Chinese Journal of Antituberculosis

摘　　要：目的:分析非结核分枝杆菌(non-tuberculous mycobacterial,NTM)性脊柱炎手术治疗患者临床特征,以提高临床诊治水平。方法:采用回顾性研究方法,参照入组标准收集并分析2023年1月至2024年9月首都医科大学附属北京胸科医院、青海省第四人民医院、哈尔滨医科大学附属哈尔滨市胸科医院骨科收治的12例经手术治疗的NTM性脊柱炎患者临床资料,包括患者人口学特征、临床症状及体征、病变部位、入院前诊断及治疗、入院后实验室检查、影像学检查、药物治疗方案、手术治疗方式及预后和随访情况。结果:12例NTM性脊柱炎患者均有1种或多种基础疾病或致免疫力低下的疾病;从发病到确诊的病程范围为12~24个月,其中,外院行抗结核治疗1年及以上者8例、6~9个月者4例。3例患者行MGIT 960液体培养,仅1例患者后续行TB-DNA检测;5例患者行NGS检测;2例患者行病理DNA诊断;2例患者行NGS+病理DNA定性。最终菌种鉴定到8种NTM,以鸟分枝杆菌复合群、胞内分枝杆菌和脓肿分枝杆菌复合群为主。术前抗NTM治疗6周者7例,8周者4例,仅1例合并肺部感染者治疗4周。4例首次手术患者,其中3例行单纯后路手术、1例因骨质破坏严重行单纯前路手术;8例再次手术患者,其中5例行前后路联合手术、1例行单纯前路手术、2例行窦道切除术,但有3例术后行3期手术或单纯窦道切除术。术后继续术前抗NTM方案治疗及康复训练8~12个月,随访2年后8例痊愈、4例有窦道或残腔(其中1例经7次手术后放弃治疗)。结论:NTM性脊柱炎多有明确职业接触史,感染菌种丰富,多因缺乏菌种鉴定而导致长期误诊误治,病程迁延,病理和分子生物学检测可明确诊断。手术治疗是病程迁延、脊柱损害严重患者的主要治疗手段,治愈率约为70%,再手术风险高,故应术前明确致病菌、精准诊断,并及时进行足量且有针对性的抗NTM治疗,以降低患者术后�Objective:To investigate the clinical characteristics of patients with non-tuberculous mycobacterial(NTM)spondylitis,aiming to enhance the quality of clinical diagnosis and treatment.Methods:A retrospective analysis was conducted on the clinical data of 12 patients with NTM spondylitis who underwent surgical treatment at the Department of Orthopedics,Beijing Chest Hospital Affiliated with Capital Medical University,the Fourth People’s Hospital of Qinghai Province,and Harbin Chest Hospital Affiliated with Harbin Medical University,from January 2023 to September 2024.The analysis included patient demographics,clinical symptoms and signs,lesion location,pre-admission diagnosis and treatment,laboratory and imaging findings,drug treatment regimens,surgical interventions,prognosis,and follow-up outcomes.Results:All 12 patients with NTM spondylitis had one or more underlying conditions or diseases associated with immunosuppression.The time from disease onset to diagnosis ranged from 12 to 24 months.Among these patients,8 had received anti-tuberculosis treatment for 1 year or more,while 4 had undergone such treatment for 6 to 9 months.Three patients underwent MGIT 960 liquid culture,with only 1 patient subsequently tested for TB-DNA.Next-generation sequencing(NGS)was performed on 5 patients,pathological DNA diagnosis on 2 patients,and combined NGS and pathological DNA characterization on 2 patients.Ultimately,8 different NTM species were identified,predominantly including the M.avium complex,M.intracellulare,and M.abscessus complex.Preoperative anti-NTM treatment consisted of a 6-week regimen for 7 patients,an 8-week regimen for 4 patients,and a 4-week regimen for 1 patient with concurrent pulmonary infection.Among these patients,3 underwent posterior-only surgical intervention,while 1 patient received anterior-only surgery due to severe bone destruction.Of the 8 patients who required reoperation,5 underwent combined anterior and posterior procedures,1 had anterior-only surgery,and 2 underwent sinusectomy.Three patient

关 键 词：脊柱炎 非典型性细菌 分枝杆菌属 疾病特征 治疗结果 

分 类 号：R52[医药卫生—内科学] R681.51[医药卫生—临床医学]