脊椎结核并侧方移位（4例报告）

目的 加深对脊椎结核并侧方移位的理解，提高对脊椎结核稳定性的认识。方法 回顾性分析近2年来脊椎结核并侧方移位4例，分析临床资料、发病机制和治疗方法。结果 4例均出现患椎的病理性骨折脱位。2例为胸腰段结核,另2例为腰椎结核。3例椎体侧方移位1度，无瘫痪，另1例椎体侧方移位2度并出现下肢完全瘫痪。经后路脊柱内固定及侧前方病灶清除、椎间植骨术治疗，效果良好。结论 脊椎结核并侧方移位好发于胸腰段和腰椎，脊柱稳定性被破坏，须行内固定治疗。     

脊柱结核MRI的临床分析

目的 回顾性观察210例脊柱结核的MRI表现，分析脊柱结核的MRI特征，结合临床讨论早期和不典型脊柱结核的MRI表现。方法 收集2000年1月至2005年12月在我院行MRI检查并经临床及手术病理证实的脊柱结核210例，其中男121例，女89例，年龄12-79岁，平均45．5岁。MRI使用PHILLPS0．23T（Panorama0．23T）常导成像系统进行扫描。结果210例脊柱结核MRI影像显示骨性脊柱、椎间盘、脊柱顺应性的改变都有其特点，同时能清晰分析椎旁软组织既流注脓肿的影像表现，特别对于椎管内占位脊髓神经受压和脊髓变性等能明确给予提示。结论 脊柱结核病变部位椎体、附件受累及椎间盘改变都有其特殊性，脊柱结核的MRI影像学表现能早期明确脊柱和椎体形态、椎体信号改变以及椎旁软组织影和寒性脓肿范围，同时能早期明确硬膜囊受压情况和脊髓受累范围，对临床早期诊断和指导治疗有重要意义。     

腰椎结核合并糖尿病患者术后系统护理效果研究

目的探讨系统护理干预在腰椎结核合并糖尿病术后的应用价值,为临床护理工作提供依据。方法选择该院2013年1月—2015年6月间收治的56例腰椎结核合并糖尿病患者,将其作为观察对象,随机对照法分成观察组与对照组,各28例。对照组采用传统常规护理干预;观察组则在常规干预基础上采用系统护理干预,比较两组患者术后的空腹血糖水平(GLU)、并发症发生率情况、护理满意度及住院时间。结果两组比较,观察组患者的空腹血糖水平要明显低于对照组,护理满意度显著高于对照组,并发症发生率低于对照组,住院时间明显较短,以上比较差异有统计学意义(P0.05)。结论在腰椎结核合并糖尿病术后行系统护理干预能够有效控制血糖,降低并发症的发生率,减少住院时间,对提升护理工作质量有重要意义。     

小切口单纯脓肿清除治疗脊柱结核112例分析

目的 探讨小切口单纯脓肿清除引流术治疗脊柱结核合并腰大肌脓肿及流注脓肿的方法、疗效及其临床意义。方法 112例脊柱结核病人在全身抗结核药物治疗的支持下，用局麻或氯胺酮全麻。小切口单纯行寒性脓肿清除术，清除脓液、干酪及肉芽组织，同时局部脓腔用大量生理盐水冲洗，术后低位放置脓腔引流管。结果 脓肿清除术后患者结核中毒症状明显好转，102例一期治愈，5例术后形成脓腔积液，3例术后瘘管形成，2例术后复发行第二次手术。结论 小切口单纯脓肿清除创伤小、手术时间短。脓肿能很好地清除干净，对脓肿毒性反应强、体质差不能耐受大手术、或骨性病灶破坏轻是一个较好的治疗方法，减小了手术风险及患者负担。     

Pseudoclavibacter Otitis Media in a 3-Year-Old Boy With Pulmonary and Spinal Tuberculosis

Pseudoclavibacter has rarely been documented as an etiologic agent of infection in humans. We presented the first case report of Pseudoclavibacter otitis media in a boy with pulmonary and spinal tuberculosis.A 3-year-old boy was referred to our hospital due to prolonged fever and progressive paraplegia for 3 months. He had yellowish discharge from both ear canals. The pleural fluid culture was positive for Mycobacterium tuberculosis. The discharge from both ears culture yielded yellow colonies of gram-positive bacilli with branching. This organism was positive for modified acid-fast bacilli stain but negative for acid-fast bacilli stain. Biochemical characteristics of this isolate were positive for catalase test but negative for oxidase, nitrate, esculin, and sugar utilization tests. The organism was further subjected to be identified by 16S ribosomal deoxyribonucleic acid gene sequencing. The result yielded Pseudoclavibacter species (99.4% identical), which could be most likely a potential pathogen in immunocompromised host like this patient. He responded well with intravenous trimetroprim-sulfamethoxazole for 6 weeks.This is the first case report of Pseudoclavibacter otitis media in children, and this case could emphasize Pseudoclavibacter species as a potential pathogen in immunocompromised host.     

改良硬膜外麻醉在66例脊柱结核并糖尿病患者中的应用观察

目的观察改良硬膜外麻醉在脊柱结核并糖尿病患者中的应用效果。方法选取132例脊柱结核并糖尿病患者按随机数字表法分成研究组和对照组各66例。对照组行常规硬膜外麻醉,研究组给予改良硬膜外麻醉。对比两组的麻醉效果、并发症及术后血糖水平。结果两组麻醉效果优良率无明显差别(P0.05);研究组并发症发生率低于对照组(P0.05);两组术后血糖水平无明显差别(P0.05)。结论改良硬膜外麻醉在脊柱结核并糖尿病患者中应用临床疗效好,安全性高。     

脊柱结核早期误用激素治疗107例分析

目的 探讨糖皮质激素的应用对脊柱结核发展及治疗影响。方法 回顾性分析我院收治的107例脊柱结核患者早期误用糖皮质激素与同期215例未用激素治疗的脊柱结核患者比较其症状、体征、治疗的结果及预后。结果 脊柱结核患者早期误用激素，造成患者发热重、脓肿大，病变部位多发及骨破坏加重，同时需延长用药时间、加大药量，术后并发症多及治愈时间延长。结论 脊柱结核患者应用糖皮质激素促使结核病情加重，影响治疗效果和预后。     

脊柱结核内固定术后复发探讨（附23例报告）

目的 探讨脊柱结核内固定术后复发原因及处理方法。方法 回顾性分析23例脊柱结核内固定术患者的发病及治疗经过以及复发后的表现和再治疗经过。重新调整抗结核药物治疗，并且用药时间为18～30个月；19例行手术病灶清除术及重新植骨，其中2例内固定物取出1例重新行内固定手术；4例单纯行瘘管清创换药。结果 23例患者19例治愈，术后安置病灶引流管相应延长到3-14天；2例耐药术后又瘘管形成，经局部换药及调整结核药物治疗，2年后痊愈，平均用药时间增加6～12个月；2例内固定取出后绝对卧床6～8个月。结论 脊柱结核内固定术后复发是严重的并发症，它影响结核的治疗和预后以及结核的播散问题；规范抗结核治疗和正确的手术时机和方法的选择应引起高度重视；及时调整抗结核药物治疗及瘘管换药和局部结核病灶的进一步清除是治愈结核复发的关键；内固定物取出不是治愈结核的关键条件。     

Anterolateral Radical Debridement and Interbody Bone Grafting Combined With Transpedicle Fixation in the Treatment of Thoracolumbar Spinal Tuberculosis

This retrospective cohort study was conducted to evaluate the clinical outcomes of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting with transpedicle fixation for the treatment of thoracolumbar tuberculosis.Spinal tuberculosis operation aims to remove the lesions and necrotic tissues, remove spinal cord compression, and reconstruct spinal stability. However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine. In addition, the patient needs to stay in bed for a long time and may have many complications. So far, the best surgical method and fixation method for spinal tuberculosis remain controversial.There were a total of 43 patients, 16 involving spinal cord injury, from January 2004 to January 2011. The patients were surgically treated for radical anterolateral debridement via posterolateral incision and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation. All the patients were followed up to determine the stages of intervertebral bone fusion and the corrections of spinal kyphosis with the restoration of neurological deficit.The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months. The function of feeling, motion, and sphincter in 16 paraplegia cases gradually recovered after 1 week to 3 months postoperatively, and the American Spinal Injury Association scores significantly increased at the final follow-up. Intervertebral bone fusions were all achieved postoperatively. No internal fixation devices were loose, extracted, or broken. There was no correction degree loss during the follow-up.The method of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation was effective for the treatment of thoracolumbar tuberculosis, correcting kyphotic deformity, and reconstructing spinal stability, obtaining successful intervertebral bony fusion and promoting the recovery of paraplegia. These results showed satisfactory clinical outcomes.     

Tuberculosis

Tuberculosis is still a leading cause of death in low-income and middle-income countries, especially those of sub-Saharan Africa where tuberculosis is an epidemic because of the increased susceptibility conferred by HIV infection. The effectiveness of the Bacille Calmette Guérin (BCG) vaccine is partial, and that of treatment of latent tuberculosis is unclear in high-incidence settings. The routine diagnostic methods that are used in many parts of the world are still very similar to those used 100 years ago. Multidrug treatment, within the context of structured, directly observed therapy, is a cost-effective control strategy. Nevertheless, the duration of treatment needed reduces its effectiveness, as does the emergence of multidrug-resistant and extensively drug-resistant disease; the latter has recently become widespread. The rapid expansion of basic, clinical, and operational research, in addition to increasing knowledge of tuberculosis, is providing new diagnostic, treatment, and preventive measures. The challenge is to apply these advances to the populations most at risk. The development of a comprehensive worldwide plan to stop tuberculosis might facilitate this process by coordinating the work of health agencies. However, massive effort, political will, and resources are needed for this plan to succeed.     

Tuberculosis

Among communicable diseases, tuberculosis is the second leading cause of death worldwide, killing nearly 2 million people each year. Most cases are in less-developed countries; over the past decade, tuberculosis incidence has increased in Africa, mainly as a result of the burden of HIV infection, and in the former Soviet Union, owing to socioeconomic change and decline of the health-care system. Definitive diagnosis of tuberculosis remains based on culture for Mycobacterium tuberculosis, but rapid diagnosis of infectious tuberculosis by simple sputum smear for acid-fast bacilli remains an important tool, and more rapid molecular techniques hold promise. Treatment with several drugs for 6 months or more can cure more than 95% of patients; direct observation of treatment, a component of the recommended five-element DOTS strategy, is judged to be the standard of care by most authorities, but currently only a third of cases worldwide are treated under this approach. Systematic monitoring of case detection and treatment outcomes is essential to effective service delivery. The proportion of patients diagnosed and treated effectively has increased greatly over the past decade but is still far short of global targets. Efforts to develop more effective tuberculosis vaccines are under way, but even if one is identified, more effective treatment systems are likely to be required for decades. Other modes of tuberculosis control, such as treatment of latent infection, have a potentially important role in some contexts. Until tuberculosis is controlled worldwide, it will continue to be a major killer in less-developed countries and a constant threat in most of the more-developed countries.     

Tuberculosis

Tuberculosis results in an estimated 1·7 million deaths each year and the worldwide number of new cases (more than 9 million) is higher than at any other time in history. 22 low-income and middle-income countries account for more than 80% of the active cases in the world. Due to the devastating effect of HIV on susceptibility to tuberculosis, sub-Saharan Africa has been disproportionately affected and accounts for four of every five cases of HIV-associated tuberculosis. In many regions highly endemic for tuberculosis, diagnosis continues to rely on century-old sputum microscopy; there is no vaccine with adequate effectiveness and tuberculosis treatment regimens are protracted and have a risk of toxic effects. Increasing rates of drug-resistant tuberculosis in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes. Moreover, our fundamental understanding of the pathogenesis of this disease is inadequate. However, increased investment has allowed basic science and translational and applied research to produce new data, leading to promising progress in the development of improved tuberculosis diagnostics, biomarkers of disease activity, drugs, and vaccines. The growing scientific momentum must be accompanied by much greater investment and political commitment to meet this huge persisting challenge to public health. Our Seminar presents current perspectives on the scale of the epidemic, the pathogen and the host response, present and emerging methods for disease control (including diagnostics, drugs, biomarkers, and vaccines), and the ongoing challenge of tuberculosis control in adults in the 21st century.     

Tuberculosis

Tuberculosis (TB) is a disease of antiquity, caused by Mycobacterium tuberculosis, which principally affects the lungs. It is a major public-health problem, with around 9 million new cases and 2 million deaths estimated to occur each year. Patients with pulmonary TB whose sputum is smear-positive for M. tuberculosis form the main source of infection in communities. About 5%-10% of infected individuals are likely to develop symptomatic TB during their lives but the risk of developing the clinical manifestations of the disease is greatly increased by HIV co-infection. The strong association between HIV and TB in sub-Saharan Africa is responsible for the massive increase in the incidence of TB observed in that region in the last 20 years. Diagnosis of TB in resource-poor countries is largely based on sputum-smear microscopy and chest radiography, although these methods lack sensitivity or specificity, especially when used on HIV-infected patients. Effective treatment has existed for 40 years but TB-attributable mortality remains high among HIV-infected patients in Africa, who are also particularly likely to develop TB again after receiving drug treatment for the disease. In Eastern Europe it is drug resistance in the local M. tuberculosis that makes the treatment of TB relatively ineffective. The approach to TB control that is now internationally recommended is the DOTS ('directly-observed treatment, short-course') strategy, which aims to prevent the transmission of M. tuberculosis, and the related illness and death, by using combinations of anti-TB drugs to treat patients with the active disease. Unfortunately, countries in sub-Saharan Africa are falling short of the World Health Organization's targets for case detection and treatment. This failure is, in turn, making the achievement of the Millennium Development Goals for TB--to ensure that the incidence of TB is falling by 2015 and to halve the prevalence of TB and the annual number of TB-attributable deaths between 1990 and 2015--less likely. To improve the performance and impact of TB-control programmes, in the face of HIV co-infection and other constraints on DOTS, the World Health Organization has launched the revised 'Stop TB Strategy'. The new strategy, to be implemented via the Global Plan to Stop TB (2006-2015), includes intensified TB-case finding, treatment of latent TB infection with isoniazid, prevention of HIV infection, cotrimoxazole preventive therapy, and antiretroviral therapy.