个体化术式联合闭合置管灌洗治疗复治脊柱结核的临床研究

Clinical study on treatment of recurrent spinal tuberculosis with individualized surgical combined with local closed tube irrigation

目的评价个体化手术联合闭合置管灌洗局部治疗复治脊柱结核的临床效果。方法复治脊柱结核患者64例,均在全身抗结核药物治疗后采用个体化手术联合术后闭合持续局部灌洗化疗,并规律抗结核治疗18~24个月。随访观察患者临床症状改善、脓肿清除和植骨融合情况。结果手术均顺利完成,所有患者无术中及术后并发症。术后给予阿米卡星生理盐水持续灌洗14~21d。未出现窦道、瘘管和脑脊膜感染,未发生引流管逆行性感染。随访24~36个月。椎间植骨节段获得骨性融合。末次随访时VAS评分和红细胞沉降率明显低于术前,脊柱功能JOA评分明显高于术前,差异有统计学意义(P<0.05)。结论个体化手术彻底清除病灶同时联合置管灌洗治疗复治脊柱结核效果良好。

Objective To evaluate the clinical efficacy of individualized surgery combined with closed catheter irrigation in the treatment of recurrent spinal tuberculosis.Methods Identified 64 cases of recurrent spinal tuberculosis were given systemic anti-tuberculosis medicine treatment before the individualized surgery combined with continuous localized lavage chemotherapy.Then all patients were treated with anti-tuberculosis drugs for 18 to 24 months after surgery.The clinical symptoms, abscess clearance and bone fusion were observed.Results All surgery was completed successfully and all patients had no intraoperative or postoperative complications.After operation, continuous lavage with amikacin normal saline was given for 14 to 21 d.No sinus, fistula and meningeal infection occurred, and there was no retrograde infection of the drainage tube.The patients were followed up for 24 to 36 months.All achieved perfect intervertebral bone fusion.At the last follow-up, the VAS score and erythrocyte sedimentation rate were significantly lower than those before surgery（P〈0.05）, and the JOA score of the spinal function was significantly higher than that before the operation（P〈0.05）.Conclusion The effect of radical debridement combined with catheter irrigation for retreatment of spinal tuberculosis is satisfactory.