复杂重症脊柱结核的治疗

Treatment of severe and complicated spinal tuberculosis

目的探讨复杂重症脊柱结核的综合治疗方法。方法 2004年6月～2009年11月共收治45例患者,男30例,女15例。入院时合并脊髓压迫13例,伴有各种并发症32例,18例伴有后凸畸形。入院后常规检查并予术前处理及化疗,行单纯后路植骨融合内固定12例,前后路联合手术18例,单纯侧前方手术15例。术后根据细菌培养和药敏试验进行抗结核治疗,持续9～12个月。结果本组患者5例失随访,40例平均随访2.7年。33例植骨融合病例骨融合时间平均为4.7个月。13例脊髓压迫患者神经功能恢复率为84.6%。结论复杂重症脊柱结核可采取化疗为主、手术为辅,既重视合并症处理,又采取相对积极的手术,同时重视病原学和病灶局部处理的综合治疗。

Objective To discuss the combined therapeutic methods for the severe and complicated spinal tuberculosis.Methods From June 2004 to November 2009,45 spinal tuberculosis patients（30 males and 15 females）,of which 13 cases were accompanied with spinal compression,32 cases were accompanied with complications,and 18 cases had kyphosis deformity were included in this study.All of the 45 cases underwent the routine checks and tests.After active preoperative treatment and effective anti-tuberculosis,12 cases were treated with posterior bone grafting and internal fixation operations,and 18 cases were treated with anterior and posterior combined operations,and 15 cases were treated with anterior operations.Regular and effective anti-tuberculosis was lasted for 9-12 months on the basis of bacterial culture and susceptibility test.Results Five patients were lost to follow up,while 40 cases were followed up for an average time of 2.7 years.The average time of bone fusion was 4.7 months in 33 cases of anterior interbody grafting operations,and 13 cases with spinal compression had a recovery rate of 84.6%.Conclusion Synthesis therapeutic method for severe and complicated spinal tuberculosis is that anti-tuberculosis in chief and operation in second,pay attention to the treatment of complications and get an active operation,and also don＇t ignore the pathogen and the focal treatment.