脊柱结核临床治疗要点回顾分析

目的 探讨脊柱结核临床治疗的要点。方法 回顾性分析2001-01-2010-01,我科收治的脊柱结核并脊髓损伤患者105例。化疗后3-4周手术,采用一期前路病灶清除、植骨、内固定手术治疗,术后严格强化四联抗结核治疗,术后3个月改三联化疗9-15个月。神经功能障碍改善情况采用ASIA神经功能评价,对其神经功能恢复、病灶愈合及内固定情况等进行分析研究。结果 1例术后3月后因结核性脑膜炎医治无效死亡。1例术后4月出现臀部脓肿复发,原发病灶未复发,再次手术清除后治愈。所有患者获随访4-12年,平均7.8年。脊柱病灶无复发。血沉均恢复正常,随访末期X线片均获骨性融合。结论 脊柱结核临床治疗要点应在标准化疗基础上尽早手术,一期病灶清除、植骨、内固定治疗,效果满意。

Analysis of treatment key point of spinal tuberculosis

Objective To discuss the treatment key point of spinal tuberculosis. Methods 105 cases with spinal tuberculosis were treated by one-stage anterior debridement,decompression,bone grafting and internal fixation,with quadruple antituberculosis treatment strictly strengthened postoperatively. And 3 months later,the triple chemotherapy was performed for 9 to 15 months. The improvement of neurological dysfunction was evaluated according to the ASIA neurological function evaluation,and the recovery of neurological function,lesions healing and internal fixation were analyzed. Results 1 case died of tuberculosis cephalomeningitis 3 months after operation. 1 case abscess over hip had a relapse 4 months later,and it was full recovered after revision operation. All patients were followed up for 4 -12 years,average 7.8 years. No recurrence of spinal lesions was observed. The last followed up X-rays showed bony heal. Conclusion The treatment key point of spinal tuberculosis is one-stage anterior debridement,decompression,bone grafting and internal fixation, which can reduce therapy cost,shorten treatment period and prevent the recurrence of spinal tuberculosis.