脊柱结核内固定术后结核复发的临床分析(附23例报告)

Clinical analysis for tuberculosis recurrence in spinal tuberculosis patients after internal fixation surgery (23 cases report)

目的探讨脊柱结核内固定术后结核复发的原因及处理方法。方法回顾性分析23例脊柱结核内固定术后复发患者的临床资料。结果本组23例复发患者均出现局部疼痛加重,血沉增高(32～132mm/h),10例合并窦道感染。CT显示13例病灶局部清除不彻底,6例出现新病灶。21例患者抗结核药物治疗不规范。4例行保守治疗,经瘘管清创换药+调整抗结核治疗后治愈;19例再次行病灶清除术及重新植骨,其中18例术后一期获得治愈,术后放置病灶引流管延长至3～14d。2例行内固定物取出术者,术后绝对卧床6～8个月治愈;2例耐药患者术后1个月瘘管形成,经局部换药及调整结核药物治疗2年后痊愈。结论脊柱结核内固定术后结核复发是严重的并发症,严格规范的抗结核治疗,选择正确的手术时机和正确的手术方法是防止脊柱结核复发的关键。

Objective To study the related reasons and treatments of tuberculosis recurrence in spinal tuberculosis patients with internal fixation surgery. Methods Clinical data of 23 cases of the tuberculosis recurrence in spinal tuberculosis after internal fixation surgery was retrospectively analyzed. Results All of the tuberculosis recurrence patients felt local pain worse and presented with heighten ESR （32-132mm/h）, and among them, 10 patients merged sinus way infection. CT showed 13 patients with residual lesions,6 cases exhibited new lesions. There were 21 patients who received nonstandard anti-tuberculosis chemotherapy. All patients received the anti-tuberculosis treatment that adjusted for 18- 30 months. Four patients cured completely by the treatment with debridement of fistula and adjusted anti-tuberculosis chemotherapy. There were 19 patients received new debridement and bone graft. Among them, 18 patients cured completely after surgery but the drainage time was prolonged to 3-14 days. The fixation was taken out in 2 cases, after then absolute bed rest was performed for 6-8 months. The fistula was formed in 2 cases with drug resistance after the surgery for 1 month. Two patients cured with the treatment of local dressing and adjusted anti-tuberculosis treatment for 2 years. Conclusions The tuberculosis recurrence is a serious complication in spinal tuberculosis patients after internal fixation surgery. In addition to standard anti-tuberculosis therapy, the right timing ,indicator,and methods of surgery are the key points to prevent the recurrence of spinal tuberculosis.