脊柱结核手术时机选择的初步研究

目的:观察脊柱结核患者手术前后红细胞沉降率(erythrocyte sedimentation rate,ESR),C-反应蛋白(C-reactive protein,CRP)及神经功能的变化,探讨手术介入时机,评价其对手术安全性的影响.方法:对2012年3月至2017年3月行手术治疗的387例脊柱结核患者进行回顾性分...

A preliminary study on the surgical timing of spinal tuberculosis

Objective: To observe the changes of erythrocyte sedimentation rate(ESR),C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery,explore the timing of surgical intervention,and evaluate its influence on surgical safety.Methods: A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017,including 278 males and 109 females,aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis,86 cases of thoracic tuberculosis,76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvement and 90 patients with multiple segmental involvement. Among them,62 cases presented neurological damage,and preoperative spinal cord neurological function depended on ASIA grade,5 cases of grade A,8 cases of grade B,39 cases of grade C,and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment,the patients were divided into group A(256 cases,receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases,receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender,age,preoperative complicated pulmonary tuberculosis,lesion site,lesion scope,surgical approach,drug resistance and other general clinical characteristics. ESR,CRP,visual analogue scale(VAS),Oswestry Disability Index(ODI),Frankel grade and postoperative complications were observed.Results: All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender,age,preoperative pulmonary tuberculosis,lesion site,lesion range,surgical approach,preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery,with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery (P<0.05),but there was no significant difference between two groups at the same time point (P>0.05). From 1 to 14 days after operation,the neurological function began to gradually recover,and the neurological function grade was increased by 1 to 3 grades. From 3 months after operation to the final follow-up,52 cases recovered completely,8 cases partially recovered,and 2 cases did not improve. There was no significant difference in ESR and CRP between two groups before admission,1 month after surgery,and final follow-up (P>0.05).Conclusion: After 2-4 weeks of anti-tuberculosis treatment before operation,patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle,patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery.