老年性脊柱结核的特点及保守治疗疗效观察

目的:探讨老年性脊柱结核的特点及单独应用抗结核药物治疗早期老年脊柱结核的疗效。方法:对2008年1月至2010年7月纳入选择标准的36例经单纯应用抗结核药物行保守治疗的老年性脊柱结核病例进行分析研究,其中男19例,女17例;年龄60～85岁,平均73.5岁。36例患者病灶均处于活跃期,血沉及CRP水平高于正常。治疗方法为联合用药(3HRZE/6-9HRE),疗程9～12个月。随诊通过观察结核症状、化验指标和放射学的影像变化以评价疗效并调整用药,通过视觉模拟评分(VAS)评价疼痛程度。结果:36例均获随访,时间8～24个月,平均15个月。其中31例患者化疗9～12个月结核病灶治愈,血沉及CRP恢复正常;4例(对利福平或异烟肼耐药)选用左氧氟沙星、对氨基水杨酸等抗结核药物化疗15个月后痊愈;1例患者结核症状加重,经手术治疗3个月后缓解,血沉及CRP恢复正常。影像学变化:治疗后X线及CT示椎体骨质硬化、融合,未见明显后凸畸形,1例手术患者植骨融合,未见内固定松动。治疗前及末次随访时Cobb角分别为(17.6±2.3)°、(18.1±2.7)°(P>0.05);MRI示椎旁脓肿吸收,椎体炎症消退。VAS评分治疗前为6.5±1.7,末次随访时为1.4±0.5(P<0.05)。7例患者出现药物不良反应,通过暂时停药并配以对症药物治疗后恢复正常。结论:对于早期老年脊柱结核病例,在严格的督导下单纯应用抗结核药物行规范的个体化保守治疗可获得满意的效果。

Analysis of clinical characteristics of elderly patients with spinal tuberculosis and its clinical effects with conservative treatment

Objective: To analyze the clinical characteristics of elderly patients with spinal tuberculosis and explore its clinical effects with anti-TB drugs alone. Methods: From January 2008 to July 2010,the data of 36 patients with spinal tuberculosis underwent conservative treatment of anti-TB drugs alone were analyzed. There were 19 males and 17 females with an average age of 73.5 years (ranged,60 to 85). All patients were in the active phase with high ESR and CRP levels and were treated with 3HRZE/6-9HRE (course from 9 to 12 months). According to clinical symptoms,chemical examination,radiological image to adjust drug and depending on VAS score to evaluate pain. Results: All the patients were followed up from 8 to 24 months with an average of 15 months. Tuberculose of 31 patients healed after chemotherapy from 9 to 12 months and ESR and CRP recovered normally. Levofloxacin and para-amino salicylic acid were used in 4 cases because of 4 cases occurred drug fast for RFP or INH,after 15 months,their obtained healing. Symptom of 1 case got worse during chemotherapy,and surgical treatment were performed,after 3 months,ESR and CRP recovered normally,X-ray and CT showed spinal osteosclerosis and fusion without significant kyphosis and internal fixation loosening. Cobb angle was respectively(17.6±2.3)°,(18.1±2.7)°before treatment and last follow-up(P>0.05). MRI showed abscess was absorbed and spinal inflammation subsidised. VAS score was respectively 6.5±1.7,1.4±0.5 before treatment and last follow-up (P<0.05). Seven patients had complications relating with drug adverse reaction,after discontinuation and treated with clinical symptom,the patients recovered normally. Conclusion: Anti-TB drugs alone can obtain satisfactory effects in treating early senile spinal tuberculosis,but strict supervision and individual administration should not be disregardful.