术后复发性胸腰椎结核的病例特点及临床意义

Characteristics and Clinical Significance of Recurrent Thoracolumbar Tuberculosis

目的回顾分析胸腰椎结核复发患者资料,总结其病例特点,为临床早发现、早治疗、改善患者预后提供指导意义。方法回顾分析我院2006年1月至2015年6月治疗的69例胸腰椎结核复发的患者,其中男性40例,女性29例;年龄5~67岁,平均(37.5±14.5)岁。胸椎结核13例,胸腰段结核20例,腰椎结核32例,腰骶椎结核4例。统计分析他们的临床表现、影像学特点及实验室检查等。结果复发的患者中,55.1%(38例)的患者出现疼痛,是最主要的临床表现。89.9%(62例)患者出现椎旁脓肿,为影像学最常见的表现。53例患者行结核细菌培养+药敏试验,共有22例患者出现耐药,耐药结核占41.5%。28例患者合并肺结核,2例患者合并肺结核及泌尿系统结核,1例患者合并结核性腹膜炎。初次复发的时间:6个月以内32例,6~12个月9例,12~18个月8例,18~24个月4例,24~36个月3例,36~48个月5例,48~60个月3例,60个月以上5例,最长时间为84个月(7年)。43例患者只复发了1次,26例患者发生多次复发,复发的患者中再次出现复发的发生率为37.7%。结论行手术治疗的胸腰椎结核患者,术后2年是复发最集中的时间节点,如出现疼痛、窦道、局部包块及神经症状,术后3个月血沉、C反应蛋白高于正常值,应警惕术后复发的可能。结合MRI、X线片及CT检查,若发现椎旁脓肿、内固定松动、骨质破坏等,应尽早采取治疗措施,对改善患者的预后有重要的临床意义。

Objective To provide guidance for early clinical discovery,early treatment and improvement of the prognosis of patients with recurrent thoracolumbar tuberculosis.Methods A retrospective analysis was made of 69 patients with recurrent thoracolumbar tuberculosis admitted to our hospital from January 2006 to 2015,including 40 males and29 females aged（37.5±14.5）years,13 cases of thoracic tuberculosis,20 cases of thoracolumbar tuberculosis and 32 cases of lumbar tuberculosis.4 cases of lumbosacral tuberculosis,a statistical analysis of their clinical manifestations,imaging features and laboratory examinations.Results Pain which is the major clinical manifestations was found in 55.1%of the recurrent patients.89.9% patients developed paravertebral abscess,which is the most common imaging manifestation.Tuberculosis bacteria culture and drug sensitivity test was performed in 53 patients.A total of 22 patients developed drug resistance.Drug resistant tuberculosis accounted for 41.5%.28 patients with pulmonary tuberculosis,2 patients with pulmonary tuberculosis associated with urinary system tuberculosis and 1 patient with tuberculous peritonitis.Before the recurrence,32 cases had 6 months,9 cases had 6 to 12 months,8 cases had 12 to 18 months,4 cases had18 to 24 month,3 cases had 24 to 36 months,5 cases 36 to 48 months,3 cases had 48 to 60 months,5 cases had 60 months or more,the longest time was 84 months（7 years）.43 patients had only one recurrence,and 26 patients recurred repeatedly.The recurrence rate was 37.7%in the recurrent patients.Conclusion 2 years after surgery is the most concentrated time for recurrence in Surgical treatment of thoracolumbar tuberculosis.If pain,sinus tract,local mass and nerve symptoms,ESR and C-reactive protein were higher than normal 3 month after operation,the possibility of recurrence after operation should be warned.If we find paravertebral abscess,internal fixation loosening,bone destruction and so on,it is very important to improve the prognosis of patients by taking treatment measures as early as possible.