颈椎结核患者的手术适应证选择和疗效分析

目的探讨颈椎结核患者手术适应证的选择和疗效并总结经验。方法从本院2013年2月~2014年5月收治的颈椎结核患者中随机性抽取30例,按照患者颈椎结核类型平均分为观察组和对照组,每组15例,对照组采用保守三联抗结核给药方式进行治疗,观察组术前先经过三联抗结核治疗,然后根据不同的手术适应证和手术术式进行手术治疗,其中7例患者行前路病灶清除内固定植骨融合术,5例患者行前后路联合手术,即后路内固定植骨融合和前路病灶清除植骨融合术,3例寰枢椎结核患者行后路颈枕融合术,前路病灶清除术。之后统计不同方式治疗后患者的治疗有效率和不良反应发生率。结果观察组的治疗有效率为93.33%（14/15）,明显高于对照组的53.33%（8/15）,差异有统计学意义（P〈0.01）。术后随访3~18个月,所有患者均康复,无明显结核病灶复发等并发症和不良反应出现。结论应用手术方法治疗颈椎结核患者效果显著,而且针对患者病情选择适合的手术适应证,对于颈椎结核的完全治愈和颈椎的康复具有重要的临床意义。

Surgical indications selection and curative effect analysis of cervical vertebra tuberculosis

Objective To study the surgical indications selection and curative effect of cervical vertebra tuberculosis.Methods 30 cases of patients with cervical vertebra tuberculosis treated in our hospital from February 2013 to May2014 were randomly selected,and were divided into observation group and control group according to the type of cervical vertebra tuberculosis,15 cases in each group,conservative triple anti-tuberculosis medication treatment was given to the control group,the observation group were taken with conservative triple anti-tuberculosis medication treatment firstly,then were given with surgical treatment according to the different surgical indications,of which,7 cases were taken with anterior debridement and internal fixation and fusion,5 cases were underwent combined anterior,that was posterior fixation and fusion and anterior debridement and fusion,3 cases of patients with atlantoaxial vertebra tuberculosis were taken with posterior occipital fusion,anterior debridement surgery.The treatment efficient and incidence of adverse reactions after different treatment were analyzed. Results The treatment effective rate of observation group was 93.00%,higher than 53.33 of the control group,the difference was significant（P〈0.01）.After 3-18 months follow-up,all patients were rehabilitation,there were no obvious complications such as recurrent tuberculosis kitchen and adverse reactions occurred. Conclusion The surgical treatment for cervical vertebra tuberculosis has better effect,and for patients choosing the suitable surgical indications,has important clinical significance for cervical vertebra tuberculosis complete healing and rehabilitation.