抗结核药物联合不同手术方法治疗脊柱结核86例疗效评价

Antituberculosis Drugs Combined with Different Operative Procedures for Treating Spinal Tuberculosis in 86 Cases

目的探讨抗结核药物联合不同手术方法用于脊柱结核的临床疗效及安全性。方法选取医院收治的脊柱结核患者86例,随机分为观察组与对照组,各43例。两组患者均给予抗结核药物治疗,血红蛋白及血沉达标后,对照组患者采用常规手术,观察组患者采用改良病灶清除、植骨融合、椎弓根钉内固定术,术后继续抗结核药物治疗1年。术前及术后2周应用美国脊髓损伤协会(ASIA)损伤分级评价患者脊髓损伤情况;观察并记录术前、术后2周及随访结束时后凸畸形情况,术后定期复查血沉及肝功能,记录手术并发症及药品不良反应的发生情况。结果治疗后,观察组患者ASIA损伤分级中A级、C级均低于对照组,E级高于对照组,差异均有统计学意义(P<0.05);两组患者术后2周、1年随访期结束时脊柱后凸畸形较治疗前明显缓解,且观察组的改善情况更显著(P<0.05)。术后,观察组患者关节断裂、植骨块滑脱和关节松动发生率均明显低于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论在抗结核药物治疗基础上,采用改良手术治疗脊柱结核能减轻患者脊柱损伤,有效纠正后凸畸形,并发症少,且不增加不良反应,值得临床推广。

Objective To investigate the clinical effect and safety of Antitubereulosis drugs combined with different operative procedures for treating spinal tuberculosis. Methods Totally 86 patients with spinal tuberculosis admitted to the hospital were randomly divided in- to the observation group and the control group,43 cases in each group. The two groups were given antituberculosis drugs, when the hemoglobin and blood sedimentation were up to the standard, the control group was given regular operation, and the observation group was given the operation of improved focus clearance,bone graft fusion and pedicle screw fixation,and the two groups were given antitu- berculosis drugs for 1 year after operation. The injury scale of spinal injury was evaluated by ASIA before operation and 2 weeks after operation; the situation of kyphosis was observed before operation, 2 weeks after operation and at the end of the follow- up, the blood sedimentation and liver function were reexamine regularly after operation,the complication and adverse drug reaction were recorded. Results After treatment,The grade A,grade C of ASIA injury scale in the observation group were significantly lower than those in the control group,but grade E was significantly higher（P 〈 0. 05）;the kyphosis in the two groups at 2 weeks after operation and the end of the follow- up were significantly remitted compare with before operation,and the improvement in the observation group was more ob- viously（P 〈 0. 05）;the incidence rate of joints fracture,Bone graft slide block and mobilization in the observation group were signifi- cantly lower than those in the control group（P 〈 0. 05）;the occurrence rate of adverse drug reactions during the treatment course had no significant difference between the two groups（ P 〉 0. 05 ）. Conclusion On the basis of the treatment of antitubereulosis drugs, the modified surgery for treating spinal tuberculosis can alleviate spinal injury,effectively correct kyphosis,has less complication and adverse drug reaction, it is worthy of clinical promotion.