脊柱结核病灶清除和植骨融合术后复发的影响因素

目的探讨脊柱结核病灶清除和植骨融合术后复发的影响因素。方法对1999年1月至2009年9月经脊柱结核病灶清除和植骨融合术治疗的脊柱结核患者407例进行随访。其中复发患者42例，男26例，女16例；年龄3．0～78．0岁，平均36．6岁。未复发患者365例，男201例，女164例；年龄5．O～69．0岁，平均38．8岁。通过对术后复发的42例与同期未复发的365例脊柱结核患者的资料做对比，并应用单因素Logistic回归和Logistic进入法回归分析，推测可能导致脊柱结核病灶清除和植入融合术后复发的影响因素。结果手术时机（术前抗结核时间）、病灶清除彻底程度、术后抗结核治疗规范程度、术后制动时间、耐药情况、是否伴有其他部位结核、不利条件（包括女性生育期、重体力劳动者、老年人、贫血或营养不良）7个因素与脊柱结核病廿崎除和植骨融合术后复发有显著相关性（P〈0．05）。结论术前正确掌握手术时机、术中病灶清除彻底、术后抗结核规范治疗、术后手术部位严格制动足够时间、应用敏感抗结核药物治疗耐药性脊柱结核、加强其他部位结核的治疗、加强营养、注意休息、避免短期内脊柱结核病灶清除和植骨融合患者术后怀孕、纠正贫血、提高机体免疫力等可以减少脊柱结核病灶病灶清除和植骨融合术后的复发。

The influential factors of recurrence after debridement and fusion for spinal tuberculosis

Objective To explore the influential factors of recurrence after debridement and fusion for spinal tuberculosis （STB）. Methods 407 patients with STB subject to debridement and fusion for spinal TB from Jan. 1999 to Sep. 2009 were analyzed. There were 42 recurrent patients, including 26 males and 16 females with age ranging from 3 to 78 years （average, 36.6 years）. There were un-recurrent 365 cases, including 201 males and 164 females with age ranging from 5 to 69 years （av- erage, 38.8 years）. The data of recurrent and un-recurrent cases were compared by single factor logistic regression and logistic regression analysis enter method. The recurrent factors after debridement and fusion for STB were evaluated. Results Seven factors were significantly correlated with recurrence （P~0.05）, including the operation time （preoperative anti-TB time）, de- gree of debridement, standard anti-TB treatment and braking time postoperatively, drug resistance, TB at other parts, adverse conditions （for example bearing period and heavy labour, the aged, anemia, and malnutrition）. Conclusion Following meas- ures may reduce the recurrence after debridement and fusion for STB, such as proper operation opportunity, complete debride- ment for lesions, standardized anti-TB treatment and enough immobilization time postoperatively, application of sensitive anti- TB drugs, strengthening the anti-TB treatment at other parts, nutrition support, adequate rest, avoiding pregnancy in short- term, correcting anemia, and improving immunity, etc.