脊柱结核术后复发因素COX回归分析

Postoperative Recurrence Factors of Spinal Tuberculosis COX Regression Analysis

目的：探讨脊柱结核术后复发的风险因素及相对风险度。尽可能避免术后复发的发生，提高脊柱结核手术治疗的治愈率。方法：将2000—01～2008—08收治的257例脊柱结核患者临床资料，应用COX比例风险回归模型分析术后复发时间与患者的年龄、性别、自身营养状况、合并脊柱外结核情况、病灶部位、手术清除病灶是否彻底、手术前及手术后是否正规化疗、手术方式（病灶清除或／和植骨术和前路清除植骨内固定术）九个因素的相关性和风险度。结果：多因素Cox回归模型分析显示术后抗结核治疗时间（RR=0．086，P=0．016）．病灶清除不彻底（RR=24．121，P=0．003）和手术方式（RR=0．074，P=0．037）三个因素与脊柱结核术后复发有相著相关性，复发患者都在术后1—2年，总的复发率为7％。结论：术后正规抗结核治疗，术中彻底清除病灶和前路病灶清除植骨内固定术能够减少脊柱结核术后复发。术后1～2年内是复发的常发时候。

Objective ：To study postoperative recurrence of spinal tuberculosis risk factors and the relative degree of risk. As far as possible to avoid the occurrence of recurrence and improve the cure rate of surgical treatment of Tuberculous spondylitis. Methods ：There were clinical data, 257 cases of spinal tuberculosis in patients during January 2000 - August 2008, which was applied to COX proportional hazards regression model, to analyse postoperative recurrence time and the 9 related factors and risk including： age, sex, self - nutritional condition, complicated spinal lesion, range of lesion, dehridement of lesion, pre - operative and post - operative regular chemotherapy, surgical method （ dehridement or/with bone graft and anterior debridement bone grafting and internal fixation）. Results： Multivariate Cox regression analysis showed that postoperative anti- TB treatment time （RR = 0. 086, P = 0. 016）, dehridement of lesion （RR = 24. 121, P = 0. 003 ） and surgical method （ RR = 0. 074, P = 0. 037 ） three factors and the recurrence of spinal tuberculosis have similar correlation, after 1 - 2 years, overall cumulative recurrence rates were 7%. Conclusions：Postoperative regular anti - TB treatment, surgery for the elimination of lesions and anterior dehridement and internal fixation can reduce the recurrence of spinal tuberculosis. Of relapse after 1 - 3 years when the centralized time.