脊柱结核术后复治原因的临床分析研究

Clinical study on the reasons for retreating postoperative spinal tuberculosis

目的探讨脊柱结核术后复治的相关原因。方法回顾性分析23例复治脊柱结核患者为观察组,同期术后顺利愈合的脊柱结核患者186例为对照组,比较2组患者的临床资料,分析影响脊柱结核术后复治的相关因素。结果观察组术前白蛋白水平以及植骨融合、术后规范抗结核治疗、手术彻底清除病灶比例均低于对照组,结核菌耐药、其他部位合并结核、不利条件比例均高于对照组,差异有统计学意义(P<0.01)。Logistic多因素回归分析结果表明术前白蛋白水平<35g/L、手术病灶清除不彻底、未行植骨融合、术后应用抗结核药物不规范、结核菌耐药、其他部位合并结核、合并不利条件均是脊柱结核术后复治的危险因素。结论术前积极营养支持、纠正贫血及治疗其他部位结核,术中彻底清除病灶、病椎行植骨融合处理,术后抗结核药物规范使用、加强管理(行腰大肌穿刺抽液注药、控制血糖)等可以减少脊柱结核的复治发生。

Objective To summarize the reasons for retreating postoperative spinal tuberculosis（TB）.Methods Twenty-three patients with postoperative recurrence of spinal TB（observation group）and 186 patients with no recurrence of spinal TB（control group）were studied retrospectively.The clinical data between two groups were compared and the correlation factors of retreating spinal TB were statistically analyzed.Results The incidence of nutrition,degree of debridement,graft bone fusion,postoperational chemotherapy in the observation group were lower than those in the control group.The incidence of drug resistance,TB at other parts,adverse conditions in the observation group were significantly higher than those in the control group（P〈0.01）.Multiple logistic regression analysis revealed that preoperative serum albumen level（35g/L）,not having standardized postoperational chemotherapy,not having completely debridement,without fusion,drug resistance,TB at other parts and adverse conditions were the risk factors of retreating postoperative spinal TB.Conclusion The early and positive therapies（nutritional support and anemia correction）,strengthening the anti-TB treatment at other parts,complete debridement for lesions, graft bone fusion, standardized anti-TB treatment,strengthening the postoperative management（psoas puncture with drewed effusion and injected drug,control of blood glucose）should be helpful to reduce retreating rate of postoperative spinal tuberculosis.