| 脊柱结核手术时机选择的初步研究 |
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投稿时间：2020-06-18
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| 作者 | Author | 单位 | Address | E-Mail |
| 金阳辉 |
JIN Yang-hui |
浙江省中西医结合医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China |
15224065775@126.com |
| 石仕元 |
SHI Shi-yuan |
浙江省中西医结合医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China |
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| 郑琦 |
ZHENG Qi |
浙江省中西医结合医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China |
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| 沈健 |
SHEN Jian |
浙江省中西医结合医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China |
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| 应小樟 |
YING Xiao-zhang |
浙江省中西医结合医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China |
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| 朱博 |
ZHU Bo |
浙江省中西医结合医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China |
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| 期刊信息：《中国骨伤》2021年，第34卷，第8期，第717-724页 |
| DOI：10.12200/j.issn.1003-0034.2021.08.006 |
| 基金项目:杭州市科技发展计划项目（编号：20180533B71） |
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中文摘要:
目的：观察脊柱结核患者手术前后红细胞沉降率（erythrocyte sedimentation rate，ESR），C-反应蛋白（C-reactive protein，CRP）及神经功能的变化，探讨手术介入时机，评价其对手术安全性的影响。
方法：对2012年3月至2017年3月行手术治疗的387例脊柱结核患者进行回顾性分析，男278例，女109例；年龄12~86（49.9±19.1）岁；颈椎结核64例，胸椎结核86例，胸腰段结核76例，腰椎结核161例；单节段受累297例，多节段受累90例。其中62例出现神经系统损害，术前脊髓神经功能ASIA残损分级：A级5例，B级8例，C级39例，D级10例。根据术前抗结核治疗时间长短分为A组（术前接受2~4周的常规四联抗结核治疗）256例和B组（术前接受>4周的常规四联抗结核治疗）131例。比较两组在性别、年龄、病变部位及范围、手术入路、术前耐药等一般临床特征上的均衡性。动态观察两组患者ESR、CRP，疼痛视觉模拟评分（visual analogue scale，VAS），Oswestry功能障碍指数（Oswestry Disability Index，ODI），Frankel分级和术后并发症等情况。
结果：387例患者均获得随访，时间12~36（18.3±4.5）个月。两组性别、年龄、病变部位及范围、手术入路、术前耐药等特征方面差异均无统计学意义。两组患者共有32例术后未愈，发生率为8.27%。两组患者手术治疗后VAS评分及ODI均明显改善（P<0.05），但两组间同一时间点差异无统计学意义（P>0.05）。术后1~14 d，神经功能开始逐渐恢复，神经功能分级提升1~3级；术后3个月至末次随访，完全恢复52例，部分恢复8例，无改善2例。两组间患者在入院前、术后1个月、末次随访的ESR、CRP差异无统计学意义（P>0.05）。
结论：脊柱结核患者术前经过2~4周的抗结核治疗，ESR、CRP处于下降期或稳定期即可进行手术。对于脊柱结核伴截瘫患者，原则上应在术前积极处理合并症后尽早手术治疗，无须急诊手术。 |
| 【关键词】脊柱结核 手术时机 安全 红细胞沉降率 C-反应蛋白 |
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| A preliminary study on the surgical timing of spinal tuberculosis |
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ABSTRACT
Objective: To observe the changes of erythrocyte sedimentation rate(ESR),C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery,explore the timing of surgical intervention,and evaluate its influence on surgical safety.
Methods: A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017,including 278 males and 109 females,aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis,86 cases of thoracic tuberculosis,76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvement and 90 patients with multiple segmental involvement. Among them,62 cases presented neurological damage,and preoperative spinal cord neurological function depended on ASIA grade,5 cases of grade A,8 cases of grade B,39 cases of grade C,and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment,the patients were divided into group A(256 cases,receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases,receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender,age,preoperative complicated pulmonary tuberculosis,lesion site,lesion scope,surgical approach,drug resistance and other general clinical characteristics. ESR,CRP,visual analogue scale(VAS),Oswestry Disability Index(ODI),Frankel grade and postoperative complications were observed.
Results: All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender,age,preoperative pulmonary tuberculosis,lesion site,lesion range,surgical approach,preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery,with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery (P<0.05),but there was no significant difference between two groups at the same time point (P>0.05). From 1 to 14 days after operation,the neurological function began to gradually recover,and the neurological function grade was increased by 1 to 3 grades. From 3 months after operation to the final follow-up,52 cases recovered completely,8 cases partially recovered,and 2 cases did not improve. There was no significant difference in ESR and CRP between two groups before admission,1 month after surgery,and final follow-up (P>0.05).
Conclusion: After 2-4 weeks of anti-tuberculosis treatment before operation,patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle,patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery. |
| KEY WORDS Spinal tuberculosis Surgical timing Safety Erythrocyte sedimentation rate C-reactive protein |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 金阳辉,石仕元,郑琦,沈健,应小樟,朱博.脊柱结核手术时机选择的初步研究[J].中国骨伤,2021,34(8):717~724 |
| 英文格式: | JIN Yang-hui,SHI Shi-yuan,ZHENG Qi,SHEN Jian,YING Xiao-zhang,ZHU Bo.A preliminary study on the surgical timing of spinal tuberculosis[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(8):717~724 |
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