| 脊柱结核术后复发原因分析及再手术疗效观察 |
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投稿时间：2013-02-16
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| 作者 | Author | 单位 | Address | E-Mail |
| 蓝旭 |
LAN Xu |
兰州军区总医院脊柱外科, 甘肃 兰州 730050 |
Department of Spinal Surgery, Lanzhou General Hospital, Lanzhou Military Command of CPLA, Lanzhou 730050, Gansu, China |
lzzyjw@sina.com |
| 许建中 |
XU Jian-zhong |
第三军医大学西南医院骨科, 重庆 400038 |
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| 罗飞 |
LUO Fei |
第三军医大学西南医院骨科, 重庆 400038 |
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| 刘雪梅 |
LIU Xue-mei |
兰州军区总医院脊柱外科, 甘肃 兰州 730050 |
Department of Spinal Surgery, Lanzhou General Hospital, Lanzhou Military Command of CPLA, Lanzhou 730050, Gansu, China |
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| 葛宝丰 |
GE Bao-feng |
兰州军区总医院脊柱外科, 甘肃 兰州 730050 |
Department of Spinal Surgery, Lanzhou General Hospital, Lanzhou Military Command of CPLA, Lanzhou 730050, Gansu, China |
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| 期刊信息：《中国骨伤》2013年，第26卷，第7期，第536-542页 |
| DOI：10.3969/j.issn.1003-0034.2013.07.002 |
| 基金项目: |
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中文摘要:
目的: 回顾性分析脊柱结核术后复发的危险因素,并对再手术治疗效果观察随访。
方法: 2002年1月至2010年5月收治27例再手术脊柱结核术后复发患者,男15例,女12例,年龄21～65岁,平均36.5岁。应用统计学方法比较分析导致术后复发的危险因素和作用强度,针对主要原因采用个体化手术治疗。再手术方式:单纯病灶清除术5例,病灶清除和窦道切除术7例,Ⅰ期经前路病灶清除植骨融合联合后路内固定术8例,Ⅰ期经后路植骨融合内固定术联合CT 引导下经皮穿刺灌注引流和局部化疗2例,单纯CT 引导下经皮穿刺灌注引流和局部化疗5例。术后加强抗结核药物治疗,定期检查血沉、X线或CT三维重建评估结核活动及植骨融合情况。
结果: 脊柱结核术后复发为多种危险因素共同作用的结果,主要原因根据作用强度大小排列为:术前术后未行正规化疗、术后积液未早期发现和处理、自身营养状况差、术中病灶清理不彻底、术后脊柱稳定性差。再次手术术中无大血管、神经或输尿管损伤,术后随访12～36个月,平均24个月。末次随访所有患者结核症状消失,无结核复发、切口感染、窦道形成或内固定失败等并发症,复查血沉正常。术后8～12个月影像学复查提示椎间隙植骨均获骨性愈合,内固定位置正常。
结论: 脊柱结核再手术原因复杂且为多因素共同作用结果,诊断和治疗难度大。术前应详细分析复发的主要原因,强调正规抗结核药物治疗和个体化手术治疗,同时应加强营养和支持治疗。 |
| 【关键词】结核,脊柱 复发 危险因素 再手术 |
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| Analysis of postoperative recurrence reason and observation of reoperation outcome for spinal tuberculosis |
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ABSTRACT
Objective: To analyze the reason of postoperative recurrence of spinal tuberculosis and observe the clinical outcome of these patients in reoperation.
Methods: From January 2002 to May 2010,27 patients with postoperative recrudescent spinal tuberculosis were treated. There were 15 males and 12 females with an average age of 36.5 years old (ranged,21 to 65). The risk factors and effect strength associated with postoperative recrudescent spinal tuberculosis were compared by Logistic regression analysis. Individual operation was performed according to the major reason. Re-operative methods including debridment in 5 cases,debridment and sinuses resection in 7 cases,one stage debridement and bone grafting via anterior approach and internal fixation via posterior approach in 8 cases,one stage bone grafting and internal fixation via posterior approach combined with CT-guided percutaneous catheter drainage and local chemotherapy in 2 cases,CT-guided percutaneous catheter drainage and local chemotherapy in 5 cases. Antituberculosis drugs were regularly used in all patients after operation. The ESR,X-ray and 3D-CT were regularly performed to estimate the progress of tuberculosis and condition of bony fusion.
Results: The risk factors associated with postoperative recrudescent spinal tuberculosis were complicated,including no regularly used antituberculosis drugs before and after operation,no early diagnosis and treatment of the postoperative fluidify,malnutrition,no thoroughly debridement during operation and poor spinal stability after operation,according to effect strength to arrange. There was no injury of blood vessel,spinal cord or ureter during reoperation. The follow-up period was from 12 to 36 months with an average of 24 months. Tuberculosis symptoms disappeared after reoperation and no complications such as tuberculosis recurrence,infection of incision,sinuses formation and internal fixation failure were found in the patients. ESR recovered normal in follow-up and bone graft obtained fusion at 8 to 12 months after operation and internal fixation position was normal.
Conclusion: The reoperative reasons of spinal tuberculosis are complicated and multifactorial. The diagnosis and treatment are difficult. It is important to analyze the recrudescent reasons thoroughly before operation,emphasize the application of regularly antituberculosis drugs and individual operation,meanwhile,reinforce nourishment and supportive treatment. |
| KEY WORDS Tuberculosis,spinal Recurrence Risk factors Reoperation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 蓝旭,许建中,罗飞,刘雪梅,葛宝丰.脊柱结核术后复发原因分析及再手术疗效观察[J].中国骨伤,2013,26(7):536~542 |
| 英文格式: | LAN Xu,XU Jian-zhong,LUO Fei,LIU Xue-mei,GE Bao-feng.Analysis of postoperative recurrence reason and observation of reoperation outcome for spinal tuberculosis[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(7):536~542 |
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