脊柱结核再手术的原因及处理方法探讨

Causes and treatment of the reoperation of spinal tuberculosis

目的:探讨脊柱结核再手术的原因及处理方法。方法:回顾性分析10例再手术脊柱结核患者的临床表现和再治疗经过。10例行病变椎体部分切除及重新植骨术,3例重新行内固定手术,术后安置病灶引流管相应延长到3～14d;重新调整抗结核药物,延长用药时间为9～12个月。结果:术后随访时间为3个月～5年,平均2.6年。10例患者治愈。结论:病灶的残留及不合理的化疗是脊柱结核再手术的主要原因。治疗成功的关键是在合理用药的基础上彻底清除病灶并充分重建脊柱稳定性。

Objective To explore the causes and treatment of the reoperation of the spinal tuberculosis. Methods Ten reoperative patients with spinal tuberculosis were retrospectively reviewed, on whom the partial excision of Pathologic vertebrae and bone grafting were performed, of which 3 were performed second instrumentation operation, the focal drainage period after operation was extended to 3～14 days and readjusted the regimen of the anti-tuberculosls chemotherapy and lasted for 9～12 months. Result The follow-up time after operation was 3 months～5 years（average time：2.6 years）.All patients were cured. Conclusions The residue of the focus of infection and the use of unreasonable regimens are the main causes of the recurrence. The key to successful treatment of the disease is to thoroughly clean up the focus of infection and sufficient rebuild spinal stability on the basis of reasonable chemotherapy regimen.