23例脊柱结核并发艾滋病患者的手术疗效观察

目的探讨手术治疗脊柱结核并发艾滋病(AIDS)患者的临床疗效。方法采用回顾性分析方法,搜集2014年1月至2018年1月成都市公共卫生临床医疗中心行手术治疗的23例脊柱结核并发AIDS患者的临床资料,包括手术时间、术中出血量、手术并发症,术前及末次随访时视觉模拟评分(VAS评分)、血红细胞沉降率(ESR)、C反应蛋白(CRP)、CD4^+T淋巴细胞计数情况、神经功能情况,以及末次随访时植骨融合情况等,分析研究对象手术治疗的效果。结果 23例患者均顺利完成手术,平均手术时间为(268.4±11.3) min,平均出血量为(490.6±101.5) ml,无手术切口感染。患者均获得随访。末次随访VAS评分为(1.0±0.7)分,明显低于术前的(8.2±0.6)分,疼痛较术前明显改善,差异有统计学意义(t=6.15,P=0.001)。4例术前有神经功能损伤的患者完全恢复正常。经抗结核药物治疗及手术治疗,末次随访时患者的ESR和CRP分别为(9.3±2.6) mm/1 h和(4.8±1.2)mg/L,较术前的(79.4±4.6)mm/1 h和(57.5±5.9)mg/L均明显下降,差异均有统计学意义(t=64.66,P=0.000;t=47.73,P=0.000);经围手术期管理及后续以高效抗逆转录病毒治疗为主的综合治疗,末次随访时患者CD4^+T淋巴细胞计数为(267.5±38.5)个/μl,较术前的(233.3±41.1)个/μl上升,差异有统计学意义(t=-36.57,P=0.001)。所有患者植骨融合符合BridwellⅠ~Ⅱ级标准,植骨融合中位时间为6个月,随访期间未见内固定器断裂。2例患者术后1 d出现癫痫,5例术后肺不张、高热,11例术后出现腹胀,对症处理后均恢复正常。结论通过加强围手术期管理、合理选择手术时机,脊柱结核并发AIDS的患者手术治疗临床效果较好。

Observation on the clinical effect of surgical treatment for 23 patients with spinal tuberculosis complicated with AIDS

Objective To explore the clinical effect of surgical treatment for patients with spinal tuberculosis complicated with acquired immune deficiency syndrome (AIDS). Methods Retrospective analysis was used to collect clinical data of 23 patients with spinal tuberculosis complicated by AIDS who underwent surgical treatment from January 2014 to January 2018 in Chengdu Public Health Clinical Medical Center, including operation time, intraoperative blood loss, surgical complications, preoperative and final follow-up visual analogue score (VAS score), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), CD4 ⁺ T lymphocyte count, nerves functional status, as well as bone graft fusion at the last follow-up. The effects of surgical treatment for those study subjects were analyzed. Results All 23 patients successfully completed the operation, with the average operation time of (268.4±11.3) min and the average bleeding volume of (490.6±101.5) ml, and without surgical incision infection. All cases were followed up. The VAS score at the last follow-up was significantly lower than that before surgery (1.0±0.7 vs. 8.2±0.6, t=6.15, P=0.001), and the pain was distinctly improved compared with that before surgery. The nerve function of 4 patients with neurological impairment before surgery completely recovered to normal. After antituberculosis treatment and surgical treatment, the ESR and CRP of the patients at the last follow-up were (9.3±2.6) mm/1 h and (4.8±1.2) mg/L, respectively, which were obviously lower than those before surgery ((79.4±4.6) mm/1 h and (57.5±5.9) mg/L), with the statistically significant differences (t=64.66, P=0.000; t=47.73, P=0.000, respectively). After perioperative management and subsequent comprehensive treatment with highly active anti-retroviral therapy, the CD4 ⁺ T lymphocyte count ((267.5±38.5) cells/μl) was increased at the last follow-up compared with preoperative count ((233.3±41.1) cells/μl), with the statistically significant difference (t=-36.57, P=0.001). All patients with bone graft fusion conformed to the Bridwell Ⅰ-Ⅱ standards. The median time of bone graft fusion was 6 months, and no internal fixator rupture was observed during follow-up. Two patients developed epilepsy 1 day after operation, 5 patients had atelectasis and high fever after operation, 11 patients had abdominal distension after operation, and all of them returned to normal after symptomatic treatment. Conclusion By strengthening perioperative management and rationally choosing surgical timing, patients with spinal tuberculosis complicated by AIDS who received surgical treatment have the better clinical effects.