脊柱结核内固定术后复发探讨（附23例报告）

Exploration on the Recurrence of Spinal Tuberculosis after Internal Fixation： A Clinical Analysis of 23 Cases

目的 探讨脊柱结核内固定术后复发原因及处理方法。方法 回顾性分析23例脊柱结核内固定术患者的发病及治疗经过以及复发后的表现和再治疗经过。重新调整抗结核药物治疗，并且用药时间为18～30个月；19例行手术病灶清除术及重新植骨，其中2例内固定物取出1例重新行内固定手术；4例单纯行瘘管清创换药。结果 23例患者19例治愈，术后安置病灶引流管相应延长到3-14天；2例耐药术后又瘘管形成，经局部换药及调整结核药物治疗，2年后痊愈，平均用药时间增加6～12个月；2例内固定取出后绝对卧床6～8个月。结论 脊柱结核内固定术后复发是严重的并发症，它影响结核的治疗和预后以及结核的播散问题；规范抗结核治疗和正确的手术时机和方法的选择应引起高度重视；及时调整抗结核药物治疗及瘘管换药和局部结核病灶的进一步清除是治愈结核复发的关键；内固定物取出不是治愈结核的关键条件。

Objective To explore the causes and treatment of the recurrence of the spinal tuberculosis after internal fixation. Methods We retrospectively reviewed 23 recrudescent patients with spinal tuberculosis who had undergone operation with internal fixation. The case history, recurrent manifestation and the treatment around recurrence were studied.Readjusted the regimen of the anti-tuberculosis chemotherapy. The treatment was extended over 18-30 months. 19 patients underwent the second debridement and bone grafting： in which 2 were taken out the internal fixation and 1 was performed second instrumentation operation. 4 patients received sinus debridement.Results 19（19/23） patients were cured. The focal drainage period after operation was extended to 3-14 days. 2 drug-resistance patients with sinus were treated by dressing change and regulative chemotherapy for 2 years. The time of anti-tuberculosis chemotherapy was extended 6-12 months. 2 patients who were taken out the internal fixation received strict bed rest for 6-8 months. Conclusions The recurrence after the instrumentation surgery of spinal tuberculosis is a severe complication. It has a bad effect on the treatment and prognosis of the tuberculosis.It can also cause disseminated tuberculosis. We should attach more importance to the standard anti-tuberculosis chemotherapy and the correct selection of the occasion and ways of the operation. The key to cure the recurrence of the tuberculosis is that adjusting the regimen of the anti-tuberculosis chemotherapy promptly, dress change of the sinus and further debridement of partial tuberculosis focus. The extraction of the internal fixature is not imperative for successful curing the recurrence of the spinal tuberculosis.