彻底与非彻底病灶清除术治疗脊柱结核的比较

Compare of complete and incomplete radical debridement for thoracolumbar spinal tuberculosis

目的探讨彻底与非彻底病灶清除术治疗脊柱结核的比较。方法回顾性分析2000年1月至2011年1月，296例脊柱结核患者资料。根据病灶是否彻底清除分为病灶彻底清除组（简称彻底组）和病灶未彻底清除组（简称非彻底组）。彻底组162例，男86例，女76例；年龄（38．74±17．26）岁；非彻底组134例，男73例，女61例；年龄（35．64±18．21）岁。行前路彻底病灶清除、髂骨或钛网支撑植骨，后路或前路器械矫形、内固定术。随访观察两组治疗效果。结果非彻底组病灶清除不彻底的病灶组织构成因素包括：残留硬化壁36．54％（76／208处）、空洞34．62％（72／208处）、病变性骨桥13．46％（28／208处）、死骨残留3．37％（7／208处）、脓肿残留7．21％（15／208处）、坏死椎间盘及非手术区病灶残留4．81％（10／208处）。平均随访时间彻底组（76．13±8．32）个月、非彻底组（79．24±5．49）个月。术后彻底组的临床表现、红细胞沉降率及C反应蛋白均明显较非彻底组改善。术后6个月结核治愈彻底组47例（29．01％）、非彻底组6例（4．48％），平均治愈时间彻底组（4．36±1．27）个月、非彻底组（9．15±2．53）个月，平均化疗时间彻底组（5．21±1．38）个月、非彻底组（10．45±2．15）个月；以上两组比较均有统计学差异。再手术率彻底组为0．62％（1／162）、非彻底组为4．48％（61134），药物不良反应率彻底组为27．16％（44／162），非彻底组为71．64％（96／134）。结论硬化壁、多发空洞、病变性骨桥是脊柱结核病灶组织的一部分；将其与传统理论的结核病灶组织一并清除的彻底病灶清除术可提高脊柱结核病灶治愈时间、缩短疗程、降低药物不良反应发生率。

Objective To explore the compare of complete and incomplete radical debridement for thoracolumbar spinal tuberculosis. Methods Data of 296 patients with spinal tuberculosis from January 2000 to January 2011 were retrospectively an- alyzed. All patients were divided into two groups according to completeness of debridement： complete debridement group （group A） and incomplete debridement group （group B）. There were 162 cases in group A including 86 males and 76 females, with an av- erage age of 38.74±17.26 years. There were 134 cases in group B including 73 males and 61 females, with an average age of 35.64± 18.21 years. All patients had undergone anterior debridement, focal graft implantation, anterior or posterior deformity cor- rection, and internal fixation. Regular follow-up was required in the two groups. Results Residual sclerotic walls （36.54%）, multi- ple cavities （34.62%）, affected bony bridges （13.46%）, sequestrum （3.37%）, abscess （7.21%） and other lesionses （4.81%） were found in the group B. The first three factors were made up 84.62% of the total. The mean follow-up time was 76.13±8.32 months in the group A and 79.24±5.49 months in the group B. The symptoms, C-reactive protein and erythrocyte sedimentation rate were im- proved more obviously in group A than those in group B. Six months after operation, tuberculosis healing rate in group A and group B was 29.01% （47 patients） and 4.48% （6 patients ）, respectively. The mean healing time was 4.36± 1.27 months in the group A and 9.15±2.53 months in the group B, with significant differences. The mean the time of chemotherapy was 5.21±1.38 months in the group A and （10.45±2.15） months in the group B, with significant differences. Reoperation rate in group A and group B was 0.62% （1/162） and 4.48% （6/134）, respectively. Conclusion Sclerotic bone, multiple cavities, and bony bridges are parts of foci in spinal tuberculosis. Clearing tuberculous foci with sclerotic bone, multiple cavities, and bony bridges can increase the curative effect, shorten the time of chemotherapy and reduce the side effects of drug, thus early resumption can be achieved.