五例脊柱结核截瘫合并结核性脑膜炎患者的临床分析及手术时机对预后的影响

Five cases of spinal tuberculosis paraplegia combined with tuberculous meningitis and analysis the timing of surgery on prognosis

目的通过对5例脊柱结核截瘫合并结核性脑膜炎患者的病史及治疗情况的回顾性分析，初步探讨了此类患者手术时机对预后的影响。方法对5例就诊于北京胸科医院结核二科及骨科的脊柱结核截瘫合并结核性脑膜炎患者的资料进行回顾性分析。所有患者均经病史、体检、脑脊液化验检查、影像学检查、实验室化验等相关检查确定诊断。结果5例患者均出现间断发热、头痛、脑膜刺激征、腰背痛及双下肢活动受限等临床表现。腰椎穿刺提示颅压正常或轻度升高，脑脊液检查细胞数可正常或升高，多以单核细胞升高为主，糖及氯化物均减低，蛋白升高，ADA可正常或升高。影像学检查提示4例合并肺部结核病灶，但痰结核菌检查均为阴性。其中3例患者给予一线抗结核药物联合喹诺酮类药物治疗，而另2例患者于抗结核治疗后行手术治疗。3例未行手术治疗的患者中1例经抗结核治疗无效死亡；另2例患者经抗结核药物治疗后结核性脑膜炎恢复，但仍存在肢体瘫痪。2例患者于抗结核药物治疗后行手术治疗，术后继续应用抗结核药物治疗，结核性脑膜炎病情稳定，双下肢肌力及感觉均有所恢复。结论对于脊柱结核截瘫合并结核性脑膜炎患者，积极规范的抗结核药物治疗是有效的，在此基础上选择合适的时机行手术治疗可改善患者预后。

Objective To explore the operation time and prognosis on spinal tuberculosis with paraplegia tu- berculous meningitis patients by retrospective analysis of the history and treatment of five cases Methods A retro- spective analysis was performed on five cases received in the 2nd department of tuberculosis and orthopedic depart- ment in Beijing Chest Hospital. All patients were confirmed the diagnosis by medical history, physical examination, cerebrospinal fluid（CSF） laboratory tests, imaging, laboratory tests, etc. Results Five patients were all manifes- ted of intermittent fever, headache, meningeal irritation, back pain and lower extremity activity limitation. Intracra- nial pressure normal or mildly elevated in lumbar puncture, CSF cell count may be normal or elevated, and mainly monocytes increased, CSF sugar and chloride were reduced, protein elevated, ADA may normal or elevated. Ima- ging examinations showed four cases of pulmonary tuberculosis, but sputum examination were negative. Three pa- tients were treated with first-line anti-TB drugs in combination with quinolone therapy, while the other two patients underwent surgery after anti-TB treatment. Three patients did not undergo surgery. One case was die of ineffective anti-TB treatment. The other two patients recovered from TBM but accompanied with limbs paralysis. Two patients underwent surgical and anti-TB drugs treatment continusely. Finally, their symptom recovered in stable condition- whose lower extremity muscle were strength and sensation recovered. Conclusion In spinal tuberculosis paraple- gia combined with tuberculous meningitis patients, choosing the right operation time with the positive standard anti- TB drugs treatment willimprove theirprognosis.