耐药脊柱结核的外科治疗

目的:探讨耐药脊柱结核的外科治疗及疗效.方法:对2005年3月至2009年4月收治的60例耐药脊柱结核的临床资料进行回顾性分析,男36例,女24例,年龄5～79岁,平均47.3岁.其中34例患者有神经受损症状,神经功能按ASIA分级标准:A级2例,B级5例,C级13例,D级14例.根据病灶部位及病变程度采用经脊柱前路、肋横突或后路病灶清除、植骨、内固定.并在药敏试验结合耐药基因检测指导下抗结核治疗12～18个月.观察患者复发、神经功能恢复、植骨融合情况.结果:所有患者均获得随访,时间1～5年,平均3.1年.2例术后复发,经再次手术治愈.神经功能受损的34例,术后改善或完全恢复.X线或CT检查提示57例患者植骨融合.结论:对耐药脊柱结核,药敏试验结合耐药基因检测指导下抗结核治疗,个体化术式选择,有较好的临床疗效.

Surgical treatment of drug-resistant spinal tuberculosis

Objective: To study the curative effect of surgical treatment of drug-resistant spinal tuberculosis. Methods: From March 2005 and April 2009,the clinical data of 60 patients with drug-resistant spinal tuberculosis were retrospectively analyzed. Including 36 males and 24 females;aged from 5 to 79 years with an average of 47.3 years. Thirty-four patients had neurological deficits,among them,2 cases were grade A,5 cases were grade B,13 cases were grade C,14 cases were grade D according to ASIA standard. According to the severity and location of the infection,the patients underwent anterior,posterolateral costotransversectomy or posterior debridement and bone grafting and internal fixation.The antituberculous chemotherapy for a total of 12 to 18 months was guided by conventional and genotypic drug susceptibility testing. Tubercular relapse,neurological function,spinal fusion were observed by ASIA grade,X-ray and CT scan. Results: All cases were followed up from 1 to 5 years with an average of 3.1 years. Recurrence was found in 2 cases who were cured after second operation. 34 cases with neurological deficits recovered totally or partially. X-ray or CT films showed spinal fusion in 57 patients. Conclusion: The therapeutic effect of individuall operative options is good in treating drug-resistant spinal tuberculosis after antituberculous chemotherapy based on conventional and genotypic drug susceptibility testing.