胸椎结核术后常见并发症的临床分析

Causes and Management Measures of Common Complications of Postoperative Thoracic Spinal Tuberculosis

目的探讨胸椎结核患者手术后相关并发症的发生原因、预防及处理对策，提高治疗的成功率。方法回顾性分析198例胸椎结核手术患者的临床资料，分析术后常见并发症发生的原因及处理办法。结果95例患者出现术后并发症，术后伤口不愈合，脓肿及窦道再次形成17例，胸腔积液，胸膜粘连51例；术中及术后脑脊液漏3例。胸背部活动受限13例，内固定物松动、折断5例，切口取骨处疼痛、麻木14例。结论手术前明确诊断，充分、规律、全程、适量、联合有效的抗结核治疗；术中充分清除结核脓肿及病灶，适当植骨及安装内固定系统；术后依据结核菌的药敏结果抗结核治疗，术后绝对卧床制动及定期复查，可减少胸椎结核手术患者的并发症。

Objective To discuss the causes, prevention approaches and treatment measures of the complications after thoracic spinal tuberculosis surgery, in order to improve the success rate of treatment. Methods Data of 198 postoperative patients with thoracic spinal tuberculosis were collected and the possible causes and treatment measures of complications were analyzed. Rusults Ninety -five patients had complications. The common complications included incision un-healing accompanied by abscess and fistula formation in 17 patients; pleural effusion and pleural adhesion in 51 patients; intra-operative and postoperative cerebrospinal fluid leakage in 3 patients; back numbness, spinal activities restriction in 13 patients; broken of the implants in 5 patients; postoperative thoracic spinal tuberculosis in ilium with bone pain,numbness and discomfort in 14 patients. Conclusion The prevention and reduction of postoperative complications relies on definite diagnosis before operations. Combination with adequate and comprehensive, regular monitoring of anti-TB therapy, radically clearance of TB abscess and focus, and conducting suitable bone grafting and internal fixation are measures in the prevention of post operative complications. Aggressive postoperative anti-TB treatment according to the results of TB drug sensitivity tests is feasible. The importance of absolute bed rest and regular out-patient follow-up should not be ignored.