脊柱结核术后内固定失稳原因初步探讨

Analysis on reasons of internal fixation instability in spinal tuberculosis

目的探讨脊柱结核患者术后内固定失稳的原因并研究相应措施。方法回顾分析2000年～2007年在两院行脊柱结核病灶清除加内固定的462例脊柱结核患者的临床资料。结果462例患者中,内固定失稳19例,失稳率为4.11%(19/462),其中6个月内出现失稳15例,占3.25%(15/462)。抗结核治疗时间≤6个月内固定失稳率比抗结核治疗时间>6个月者显著增高(P<0.01)。佩戴支具时间≤6个月内固定失稳率比佩戴支具时间>6个月者显著增高(P<0.01)。术后卧床时间≤3个月内固定失稳率比术后卧床时间>3个月者显著增高(P<0.01)。术者为中级职称者术后内固定失稳率比术者为高级职称者显著增高(P<0.05)。术后负重重量≥50kg者内固定失稳率比负重重量<50kg者显著增高(P<0.05)。结论脊柱结核病灶清除加内固定术术后内固定失稳的危险因素有抗结核时间不足疗程、佩戴支具时间过短、术后卧床时间不充分、术后过度负重、术者为中低职称者。术后规则抗结核治疗、佩戴支具时间足够长、卧床时间充分、避免过度负重和提高术者技术水平可降低脊柱结核术后内固定失稳率。

Objective To analyze the reasons of internal fixation instability in spinal tuberculosis and to study the surgical management of spinal tuberculosis. Methods A total of 462 cases of spinal tuberculosis which had been treated with internal fixation between 2000 and 2007 were reviewed. Results Nineteen cases of them had fixation instability with an instability rate of 4.11% （19/462）. The internal fixation instability rate of anti-tuberculosis time no more than 6 months increased significantly compared with that of anti-tuberculosis time more than 6 months （ P 〈 0.01 ）. The internal fixation instability rate of brace wearing time no more than 6 months increased significantly compared with that of brace wearing time more than 6 months （P 〈0.01 ）. The internal fixation instability rate of bed lying time no more than 3 months increased significantly compared with that of bed lying time more than 3 months （ P 〈 0.01 ）. The internal fixation instability rate of the surgical doctor own a intermediate professional title increased significantly compared of that with the surgical doctor own a senior professional title （P 〈 0.05 ）. The internal fixation instability rate of postoperative weight wearing no less than 50 kg increased significantly compared with that of postoperative weight wearing less than 50 kg （ P 〈 0.05 ）. Conclusion The risk factors for postoperative internal fixation instability after removal of spinal tuberculosis focus combined with internal fixation are anti-tuberculosis time short of treatment course, brace wearing time too short, bed lying time not enough, over weight wearing, intermediate professional title. Standardized anti-tuberculosis therapy, enough brace wearing time, sufficient bed lying time, avoiding over weight wearing and improving the surgical technique can decrease postoperative internal fixation instability.