317例脊椎结核并发瘘管的治疗分析

The Treatment Complicated of Tuberculosis of the Spinewith Sinus—A Report of 317 Cases

我科自1954～1985年共收治脊椎结核并发瘘管317例。共中颈椎7例,胸椎38例,胸腰椎85例,腰椎148例,腰骶椎59例。采用杭结核、抗感染、瘘管换药及外科手术综合治疗。291例行病灶清除术及瘘管切除术,26例保守疗法治愈。随访195例。治愈率为93.9%。未治愈及复发10例,其中7例为慢性硬化性骨髓炎。作者强调术前抗结核治疗、控制继发感染的重要性,并讨论了手术的适应证。

Three hundred and seventeen cases of tutberculosis of the spine with sinus tract formaion which were treated between 1954 and 1988 were reviewed. The disease location breakdown was as follows: 1) cervical spine, 7 cases; 2) thoracic spine, 38 cases; 3) thoraco-lumbar spine, 65 cases; 4) lumbar spine, 148 cases; and 5) lumbo-sacral spine, 57 cases.The treatment regimen consisted of antituberculosis drugs, local drainage, and focal debridement. Focal debridement and sinuotomy was performed in 291 cases. Twenty six cases healed with conservative medical therapy.Of the 195 cases which were followed up, the cure rate was 94.9%. Recurrence took place in 10 cases. Of these 10, seven were of the sclerotic osteomyelitis type with long standing sinuses.The authors stress that adequate antituberculosis and antiseptic therapy is of great value and importance in the preoperative stage. The indications for surgery are also discussed.