小儿脊柱结核术后迁延不愈或复发:再次个体化植入物修复效果评价

Delayed healing or post-operative recurrence in pediatric spinal tuberculosis:efficacy of individualized re-operation

背景:目前由于耐药结核杆菌的出现、结核患者的管理不当等原因,脊柱结核术后结核迁延不愈或者复发的患者逐渐增加,尤其是易感性较强的小儿患者。因此对于小儿脊柱结核术后迁延不愈或复发的高危因素研究,对于结核的防治有重要的意义。目的:总结分析小儿脊柱结核术后结核迁延不愈或复发的相关危险因素,评价其个体化再次修复治疗的效果。方法:回顾性分析1998年6月至2013年6月行手术治疗145例脊柱结核患儿的临床资料,对其中术后脊柱结核迁延不愈或者复发患儿的临床资料与同期其他患儿进行对比,应用Logistic回归分析比较两组患儿的年龄、性别、自身营养情况、病灶清除是否彻底、修复前后正规化疗、是否置入内固定、伴发脊柱外结核、病灶范围、术前血沉>60 mm/h、术后出现并发症与脊柱结核术后迁延不愈或复发的相关性,分析可能导致脊柱结核术后迁延不愈或复发的危险因素;对于再次修复治疗的患儿,定期复查血沉、C-反应蛋白以及影像学指标,评价修复效果。结果与结论:29例患儿术后出现了结核的迁延不愈或复发,其中12例患儿再次行修复治疗,小儿脊柱结核术后迁延不愈或复发的发生率为20%,再手术率为8.3%。Logistic回归分析提示自身营养情况、修复前后正规化疗、病灶清除是否彻底、病灶范围与术后脊柱结核的迁延不愈或复发存在显著相关性(P<0.05);年龄、性别、是否置入内固定、伴发脊柱外结核、修复前血沉>60 mm/h、修复后出现并发症与小儿脊柱结核术后迁延不愈或复发无相关性(P>0.05);个体化的再次修复治疗可获得良好的效果。提示小儿脊柱结核术后迁延不愈或复发的原因复杂,加强自身营养、彻底清除病灶、严格正规化疗可以有效减少小儿脊柱结核术后迁延不愈或复发。根据初次修复方式结合患儿的具体病情制定个体化的再次修复方案是治疗脊柱结核术后迁延不愈或复发成功的关键。

BACKGROUND： Due to the emergence of drug-resistant tuberculosis and mismanagement in tuberculosis patients, the incidence of delayed healing or recurrent after spinal tuberculosis surgery is gradually increasing, especially in strongly predisposal children. Therefore, exploring the risk factors of delayed healing or post-operative recurrence in pediatric patients after spinal tuberculosis surgery, will have significance in the prevention and treatment of tuberculosis. OBJECTIVE： To analyze the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis and evaluate the efficacy of individualized re-operation. METHODS： From June 1998 to June 2013, clinical data of 145 pediatric patients with spinal tuberculosis were reviewed retrospectively, and some cases of delayed healing or post-operative recurrence in spinal tuberculosis were comPared with other without delayed healing or post-operative recurrence. The patient＇s age, gender, nutritional condition, lesion debridement, history of chemotherapy and internal fixation, complicated spinal lesion, scope of lesions, preoperative erythrocyte sedimentation rate 〉 60 mm/h, and postoperative complications were analyzed by Logistic regression analysis. The risk factors of delayed healing or post-operative recurrence were analyzed. After re-operation, erythrocyte sedimentation rate, C-reactive protein and imaging studies were detected. RESULTS AND CONCLUSION： After surgery, 29 cases appeared delayed healing or post-operative recurrence and 12 of them received re-operation. The incidence of delayed healing or post-operative recurrence in pediatric spinal tuberculosis was 20% and the re-operation rate was 8.3%. Logistic regression analysis showed that, nutritional condition, history of chemotherapy, lesion debridement, and scope of lesions were significantly correlated with delayed healing or post-operative recurrence （P 〈 0.05）. While patient＇s age, gender, history of internal fixation, complicated spinal lesion, preoperative erythrocyte sedimentation rate 〉 60 mm/h, and postoperative complications had no correlation with the delayed healing or post-operative recurrence （P 〉 0.05）. Individualized re-operation can achieve good outcomes. Experimental findings indicate that, the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis are very complex, enhancing the nutrition, complete debridement of lesions, and receiving chemotherapy can effectively decrease the incidence. According to the initial surgery and patient＇s conditions, individualized re-operation is the key to the success.