超短程化疗方案及病变椎体部分切除术治疗脊柱结核

Treatment of spinal tuberculosis with ultra-short-course chemotherapy and partial excision of pathologic vertebrae

目的探讨三种化疗方案及病变椎体部分切除术治疗脊柱结核的临床效果.方法1998年12月至2003年11月,将收治的76例脊柱结核分为三组:超短程化疗组38例,化疗方案2SHRZ/2.5H2R2Z2,疗程4.5个月;短程化疗组23例,方案为3SHRZ/5H2R2Z2,疗程8个月;标准化疗组15例,方案为3SHRZ/9 H2R2Z2,疗程12个月.术前化疗时间三组基本相同,为15～40 d,平均21 d.全部病例均采用前路病变椎体部分切除、大块髂骨支撑植骨、前路或后路内固定手术.结果超短程、短程和标准化疗组平均随访时间分别为23、28和45个月.观测指标为:(1)临床表现:结核病症状消失,一般情况良好,无主诉疼痛,恢复正常工作或生活;体温正常,病变局部无叩击痛;神经功能恢复;术后1个月下地,4～5个月恢复工作.(2)实验室检查:ESR、CRP两项或一项正常或接近于正常.(3)影像学检查:X线片、CT、MRI见脓肿消失,无新生破坏灶,无植骨床与植骨吸收现象,植骨界面出现骨愈合征象,畸形矫正满意、矫正角度丢失＜5°.(4)B超:可能出现椎旁脓肿或流注脓肿的部位无液性暗区.(5)药物并发症:随访时肝、肾功能正常或基本正常.随访时三组均达到以上标准,为优良效果,并且三组效果相同.结论超短程化疗、短程化疗和标准化疗方案结合前路脊柱结核病变椎体部分切除植骨、前路或后路内固定术治疗脊柱结核效果均达到优良.超短程化疗与短程化疗、标准化疗方案的效果均满意.

Objective To evaluate the clinical efficacy of three chemotherapy regimens and partial excision of the affected vertebrae for spinal tuberculosis. Methods Between December 1998 and November 2003, 76 cases with spinal tuberculosis were treated with chemotherapy and surgical intervention. All pa-tients were divided into three groups randomly to receive one of three different courses of chemotherapy. Among these, 38 cases were selected to receive ultra-short-course chemotherapy regimen with 2SHRZ/ 2.5H2R2Z2, 23 of short-course with 3SHRZ/5H2R2Z2, and 15 of standard with 3SHRZ/9H2R2Z2. The duration of the preoperative chemotherapy of the three groups was about the same with an average of 21 days (15 to 40 days). All patients underwent anterior partial excision of the affected vertebrae, large iliac strut graft and anterior or posterior fixation. Results The mean follow-up time of the ultra-short-course, short-course and standard chemotherapy groups were 23, 28 and 45 months respectively. The observed indices included: 1) Clinical manifestation: disappearance of TB symptoms, the nerve function recovered, life and the work activ-ities. 2) Lab tests: both ESR and CRP data or either of them in normal or near normal status. 3) X-ray, CT and MRI examination: abscesses, new lesion, absorption of the bone grafts, translucent line between bone graft and vertebral body, and correction of kyphotic deformity. 4) Ultrasonic examination: no opaque dark area at the sites where there might be the paravertebral or gravity abscesses. 5) Drug complications: the hepatic and renal function of patients at follow up were normal or close to normal. The follow-up showed that all the three groups achieved excellent results. Conclusion Treatment of spinal tuberculosis with anterior partial excision of pathologic vertebrae, large iliac strut graft and anterior or posterior internal instrumental fixation in either ultra-short-course, short-course or standard chemotherapy all achieved excellent therapeutic effects. There was no difference among three different courses of chemotherapy.