653例胸椎结核临床特点分析

目的 分析胸椎结核临床特点。方法 回顾性收集并分析2011年1月至2018年12月首都医科大学附属北京胸科医院诊断为胸椎结核的653例患者病案首页临床资料,包括人口学特征、临床表现、病理组织及实验室检查、手术方案选择等。结果 653例胸椎结核患者的发病年龄较大49.0(30.0,62.0)岁]、病程较长6.0(3.0,12.0)个月]、背痛者较多78.1%(510/653)],主要依靠组织病理诊断81.0%(417/515)]。外埠患者65.7%(429/653)]多于本埠患者34.3%(224/653)],且本埠65岁及以上老年患者发病率34.8%(78/224)]高于外埠患者14.0%(60/429)](χ²=38.330,P<0.001)。中、下段胸椎受累达91.4%(597/653),累及2个椎体者最多69.5%(454/653)],其次为3个及以上椎体者28.2%(184/653)],截瘫患者达30.5%(199/653),接受手术治疗者达83.2%(543/653),其中术后出现并发症者99例(18.2%)。截瘫患者入院时血红细胞沉降率35.0(16.0,66.3)mm/1h]、贫血36.7%(73/199)]、接受手术时间210.0(168.5,250.0)min]和术中出血量600.0(400.0,1000.0)ml]均明显高于非截瘫组27.0(11.0,55.5)mm/1h、24.7%(112/454)、201.0(150.0,240.0)min、500.0(400.0,800.0)ml](Z=-2.867,P=0.004;χ²=9.835,P=0.002;Z=-2.494,P=0.013;Z=-3.182,P<0.001)。最终术后出现并发症者经积极处理均痊愈,好转出院581例(89.0%),转往其他医疗机构继续康复或治疗基础疾病61例(9.3%),截瘫未愈8例(1.2%),死亡3例(0.5%)。结论 胸椎结核发病年龄较大,病程较长,中下胸椎受累及累及2个及以上椎体多见,病理是主要的确诊方式。手术是胸椎结核的重要治疗手段,截瘫患者病情较重,手术难度增加,但总体治疗效果良好。

The clinical features of 653 cases of thoracic spinal tuberculosis

Objective: To depict the clinical features of thoracic spinal tuberculosis patients. Methods: A total of 653 thoracic spinal tuberculosis cases diagnosed between January 2011 and December 2018 in Beijing Chest Hospital were enrolled retrospectively.The demographic characteristics,clinical features, outcomes of pathological examination and laboratory testing, and the way of surgery of the cases were investigated. Results: The median age of the enrolled patients was 49.0 (30.0,62.0) years old,the median course before the surgery was 6.0 (3.0,12.0) months. 78.1% (510/653) of them had back pain as the chief complaint and 81.0% (417/515) were diagnosed according to the pathological examination outcomes. 65.7% (429/653) of the enrolled patients came from the outside Beijing, and more aged patients (over 65 years old) were observed in local patients than in patients from outside Beijing (34.8% (78/224) vs. 14.0% (60/429);χ²=38.330,P<0.001). 91.4% (597/653) of the cases had their middle and/or lower thoracic vertebra involvement, and 69.5% (454/653) of them had 2 vertebral bodies involved, and 28.2% (184/653) had 3 or more. 83.2% (543/653) underwent operations and 18.2% (99/543) of them had postoperative complications. 30.5% (199/653) of the cases were paraplegic patients, and the median sedimentation rate of red blood cells (ESR)(35.0 (16.0,66.3) mm/1 h),anemia happening rate (36.7%, 73/199),the median duration of the operation (210.0 (168.5,250.0)) and the blood lost during the operation (600.0 (400.0,1000.0) ml) of the paraplegic patients were significantly different with these of the non-paraplegic patients (27.0 (11.0,55.5) mm/1 h, 24.7% (112/454), 201.0 (150.0,240.0) min, 500.0 (400.0,800.0) ml)(Z=-2.867,P=0.004;χ²=9.835,P=0.002; Z=-2.494,P=0.013; Z=-3.182,P<0.001). Finally, all postoperative complications recovered after treatment, 581 patients (89.0%) got better and left hospital, 61 patients (9.0%) were transferred to other medical institutions for further rehabilitation or treatment of basic diseases, 8 patients were not recovered from paraplegia (1.2%), and 3 patients died (0.5%). Conclusion: Thoracic spinal tuberculosis patients are generally at old age with long preoperative course, and 2 or more vertebral bodies of the middle and/or lower thoracic vertebra involvement are common. Pathological examination is the main way to provide evidence for diagnosis, and operation is an important means of treatment. The operation of the paraplegic patients takes longer time and is generally more complicated.