胸、腰椎结核病灶清除联合应用局部缓释抗结核药物的疗效分析

Debridement combined with local anti-TB drugs delivery for thoracic and lumbar spine tuberculosis

目的探讨胸、腰椎结核病灶清除后联合应用局部缓释抗结核药物以达到控制病灶感染的临床疗效。方法对2008年10月至2011年1月采用手术治疗且随访资料完整的18例胸、腰椎结核患者（其中2例为翻修病例）的临床资料进行回顾性分析，男性12例，女性6例；年龄22～67岁，平均（48．7±13．3）岁。病变累及范围为T8～S1。14例为单纯后路手术，4例为前、后路联合手术。病灶清除后均采用OSTEOSET系列RBK药物载体型人工骨混合异烟肼、链霉素，联合自体骨植骨内固定。化疗期间监测肝、肾功能，血常规，红细胞沉降率及C反应蛋白。采用疼痛视觉模拟评分（visual ana-logue scale，VAS）、Frankel分级及Cobb角评估术后疼痛、脊髓神经损害和后凸畸形的改善情况，并观察结核治愈情况和植骨融合情况。结果患者切口均一期愈合。随访时间29～56个月，平均39．5个月。所有患者临床症状均得到明显缓解，围手术期未见明显肝肾功能异常，未发现耳毒性及局部神经刺激症状。1例L2,3结核患者术后18个月局部复发。术后6月，18例患者的植骨均得到融合，无内固定并发症，后凸矫正角度无明显丢失。结论OSTEOSETRBK药物载体型人工骨混合链霉素、异烟肼局部应用联合病灶清除治疗胸、腰椎结核，有利于控制病灶感染，术后复发率低；联合应用自体骨植骨有助于骨融合。

Objective To investigate a therapeutic method which could provide sustained-release delivery and local long- lasting anti-TB treatment after debridement of thoracic and lumbar spine tuberculosis. Methods Data of 18 patients （including 2 revised cases）, who were diagnosed of thoracic and lumbar tuberculosis and required surgery treatment from October 2008 to Janu- ary 2011 were retrospectively analyzed. There were 12 males and 6 females, with an average age of 48.7± 13.3 years （range, 22 to 67 years）. Affected spinal segments in these patients spanned from T8 to S1. fourteen patients were treated with posterior surgical procedure alone while the other 4 were treated with one-stage combined anterior-posterior surgery. Combined with autogenous bone, OSTEOSET RBK drug carrier-type artificial bone mixed with isoniazid and streptomycin was used after debridement. Clini- cal parameters including clinical symptoms, laboratory results, and imaging data were evaluated during follow-up. Results Inci- sions of all patients achieved primary healing. The duration of patient follow-up ranged from 29 to 56 months （average, 39.5 months）. No liver and kidney function abnormalities, ototoxicity, or local nerve irritations were found perioperatively. Improve- ments in clinical symptoms were observed in all patients. One patient with L2.3 tuberculosis recurred 18 months after the initial sur- gery. At 6-month follow-up, intervertebral body fusion was achieved without complications of internal fixation or significant angle loss of kyphosis correction. Conclusion OSTEOSET RBK drug carrier-type artificial bone mixed with isoniazid, streptomycin for treatment of thoracic and lumbar spine tuberculosis is a safe and effective way to control local infection and recurrence. Combined with autologous bone could contribute to bone fusion.