经典病灶清除手术治疗复杂复合性脊柱结核104例临床分析

Clinical analysis of classic debridement surgery in the treatment of 104 patients with complex and compound spinal tuberculosis

目的探讨用经典病灶清除术治疗复杂复合性脊柱结核的外科围手术期处理及手术方法和手术时机的选择,以减少此类患者的手术并发症。方法回顾性分析104例复杂复合性脊柱结核患者,对其临床特点进行分析,采用经典病灶清除手术,对手术效果进行临床分析。结果104例患者无死亡及心、肺、肝、肾等器官的严重并发症。104例患者中90例是第一次手术,术后切口1期愈合82例,1期愈合率91.1%(82/90),余8例经换药引流愈合,未在同一侧进行第二次手术。外院(指第三家医院)转来的14例患者中,分别在对侧行病灶清除,原刀口行窦道切除术后治愈。所有患者术后3个月复查血红细胞沉降率均恢复正常,X线检查显示:椎体呈骨性融合者65例,纤维融合者39例。随访2年,所有患者均无复发,X线复查显示椎体均呈骨性融合,达到临床治愈。结论谨慎对待复杂复合性脊柱结核患者的外科治疗手术时机和手术技巧,在抗结核药物治疗基础上,采用经典病灶清除手术治疗复杂复合性脊柱结核可以取得满意疗效。

Objective To explore the perioperative management,the surgical techniques and operation time of classic debridement surgery in the treatment of complex and compound spinal tuberculosis,in order to reduce the complications of these patients.Methods Clinical effects of 104 patients with complex and compound spinal tuberculosis of classic debridement surgery were retrospectively analyzed.Results The 104 patients had no death and serious complications with heart,lung or kidney.Among the 104 patients,90 cases were performed for the first surgery,in which postoperative primary healing rate was 91%（82/90）,the left 8 cases were healed after dressing and drainage,not for a second surgery on the same side.The 14 cases from the other hospital（referring to the third hospital） were healed.The lesions were removed through debridement in the opposite line,the sinus tract of the original knife-edge line were healed by resection.ESR of all the patients was normal after 3 months.X-ray showed that 65 cases had vertebral bone fusion,39 had fiber fusion.All the patients were clinically healed and had no recurrence of tuberculosis at the follow-up for 2 years,and X-ray showed that all patients had vertebral bone fusion.Conclusion Carefully treating the patients with complex and compound spinal tuberculosis,exactly handling the surgical opportunity and surgical technique on the basis of antituberculosis chemotherapy,we can achieve satisfactory results with classic debridement surgery.