少儿脊柱结核的临床特点分析

Spinal Tuberculosis in Children： a Retrospective Study of 112 Cases

目的总结少儿脊柱结核的临床特点，为其诊断和治疗提供参考。方法对2006年1月-2012年12月我院收治的112例少年儿童脊柱结核患者归纳分析其首诊原因、病程、受累节段、受累椎体数、后凸Cobb角、瘫痪情况，并分析病程、受累椎体数和后凸Cobb角之间的相关性，同时根据年龄将患者分成婴幼儿（0—3岁）、学龄前儿童（4～6岁）、学龄儿童（7～12岁）、少年（13-17岁）四组并进行比较。将脊柱分为脊柱上段（颈段、颈胸段、胸段）和脊柱下段（胸腰段、腰段、腰骶段和骶段）并对其所占的比例进行比较。根据脊髓神经功能将患者分为瘫痪组和非瘫痪组，比较两组的病程、受累椎体数和后凸Cobb角。根据后凸Cobb角，以30°为界分为两组，比较其瘫痪发生率。结果少儿脊柱结核最常见首诊原因为疼痛，病程平均5.3±10．9个月（1．5～72个月），受累椎体数平均2．9±1．0个（1—6个），累及胸椎最为常见。后凸Cobb角平均15．7°±17．0°（0～90．5°），后凸Cobb角、受累椎体数、病程之间有相关性（r为0．384～0．666，P〈0．05）。瘫痪组的Cobb角角度、受累椎体数和病程均显著大于非瘫痪组（P〈0.05）；Cobb角兰30°组发生瘫痪的比率（11／18，61．1％）明显高于Cobb角〈30°组（12／70，17．1％）。比较四个年龄组的患者，疼痛和瘫痪在首诊原因中所占的比率具有显著性差异（χ^2=32．695，P〈0.05）；瘫痪发生率具有显著性差异，婴幼儿组（8／19，42．1％）和学龄前儿童组（8／31，25．8％）发生瘫痪的比率明显高于学龄儿童组（4／39，10．3％）和少年组（3／23，13．0％）。四个年龄组患者的病程、脊柱上段和脊柱下段的发病率、受累椎体数、后凸Cobb角无显著性差异（P〉0．05）。结论少儿脊柱结核以疼痛首诊和病变累及胸椎最为常见，其后凸Cobb角、受累椎体数和病程之间具有相关性。少儿脊柱结核中瘫痪患者的后凸Cobb角、受累椎体数和病程均显著大于非瘫痪患者。幼儿和学龄前儿童以及后凸Cobb角≥30°者发生瘫痪的几率较高。

Objectives To analyze the clinical characteristics of children with spinal tuberculosis （TB）, and to provide references for its diagnosis and therapy. Methods A retrospective analysis of 112 children with spinal TB from January 2006 to December 2012 was carried out, the first complaint, duration, the segments involved, the number of vertebrae involved, the kyphotie Cobb angle and paralysis were reviewed. The correlation between duration, the number of vertebra involved and the kyphotic Cobb angle were analyzed. At the same time, the patients were divided to infant group （0-3 years）, preschool children group （4-6 years）, schoolage children group （7-12 years） and juvenile group （13-17 years）. The spine was divided into upper spine （cervical, thoracic and cervicothoracic segment） and lower spine （thoracolumbar, lumbar, lumbosacral and sacral segments）. The morbidity of both upper and lower spine was compared. According to the neurological function, the patients were divided into paralysis group and non-paralysis group. The duration, number of vertebra involved and kyphotic Cobb angle of between two groups were compared. According to the kyphotic Cobb angle, the patients were divided into no less than 30° group and less than 30° group. The morbidity of paralysis were compared between two groups. Results In these patients, pain was the most common first complaint and thoracic segment involved was most common. The average disease duration and number of vertebras involved was 5.3 ± 10.9 months and 2.9 ± 1.0 respectively. The average kyphotic Cobb angle was 15.7°± 17.0°. Significant correlations were found for the kyphotic Cobb angle, the number of vertebrae involved and duration （r=0.384-0.666, P〈0.05）. There was significant difference between paralysis group and non-paralysis group with regard to the kyphotie Cobb angle, the number of vertebrae involved and duration （P〈0.05）. There was significant difference between the group with the kyphotic Cobb angle of no less than 30° and the group with kyphotic Cobb angle of less than 30° in regard to the paralysis rate （61.1% and 17.1%, respectively）. There was significant difference among the four different age children groups with regard to the rate of pain and paralysis in the first complaint （P〈0.05） . The paralysis rate of infant and preschool children groups was obviously higher than that of school-age children and juvenile groups （42.1%, 25.8%, 10.3% and 13.0%, respectively）. No significant difference was found among the four age children groups with regard to duration, the morbidity of upper and lower spinal segment, number of vertebrae involved, kyphotic Cobb angle （P〉0.05）. Conclusions Pain was the most common first complaint and thoracic segment was most common segment involved in children with spinal TB. Significant correlations were found among the kyphotic Cobb angle, the number of vertebra involved and duration. There was significant difference between paralysis group and nonparalysis group in regard to the kyphotic Cobb angle, the number of vertebra involved and duration. The paralysis rate of infant and preschool children or the kyphotic Cobb angle of no less than 30° was higher.