胸椎结核患者脊髓损伤后手术时机的选择及其对疗效的影响

Timing o f surgery afte r thoracic spinal cord injury and its effect on curative effect in patients with thoracic spinal tuberculosis

目的探讨胸椎结核患者脊髓损伤后手术时机的选择及其对疗效的影响。方法选取河西学院附属张掖人民医院骨科自2013年2月至2016年7月收治的胸椎结核合并脊髓损伤患者150例,依据脊髓损伤后手术时机分为即刻组(即刻)、早期组(抗结核治疗2～4周)、常规组(抗结核治疗>4周),每组50例,比较3组患者手术时间、术中出血量、植骨融合时间、并发症发生率、复发率、红细胞沉降率(ESR)、疼痛、神经功能情况。结果在手术时间、术中出血量、植骨融合时间方面,即刻组、早期组明显低于常规组,即刻组的并发症发生率明显低于常规组,差异均有统计学意义(P<0.05),即刻组与早期组比较,差异无统计学意义(P>0.05);在美国脊髓损伤协会(ASIA)评分方面,3组患者术后明显高于术前,即刻组、早期组明显高于常规组,差异有统计学意义(P<0.05),即刻组与早期组比较,差异无统计学意义(P>0.05);3组患者术后ESR、疼痛视觉模拟评分法(VAS)评分明显低于术前,即刻组术后ESR、VAS评分及复发率明显高于早期组、常规组,差异均有统计学意义(P<0.05),早期组与常规组术后ESR、VAS评分及复发率比较,差异无统计学意义(P>0.05)。结论胸椎结核患者脊髓损伤后手术时机的选择应在规范抗结核治疗、损伤后2～4周,可有效减少患者的手术创伤、并发症并利于神经功能恢复。

Objective To discuss the timing of surgery after thoracic spinal cord injury and its effect on curative effect in patients with thoracic spinal tuberculosis. Methods One hundred and fifty thoracic spinal tuberculosis patients with thoracic spinal cord injury were selected from February 2013 to July 2016 in Zhangye People’s Hospital Affiliated to Hexi University, according to the timing of surgery after spinal cord injury were divided into immediategroup (immediate), early group (anti tuberculosis treatment 2-4 weeks), conventional group (anti tuberculosis treatment >4 weeks), 50 cases in each group. The operation time, intraoperative bleeding volume, fusion time, complication rate, recurrence rate, erythrocyte sedimentationrate (ESR), pain and nerve function were compared among the 3 groups. Results In operative time, bleeding volume, bone fusion time, instant group, early group was significantly lower than the normal group, the complication rate in early group was significantly lower than the normal group, the difference was statistically significant (P<0.05) immediate group and early group, there was no statistically significant difference (P>0.05) in the United States;Spinal Cord Injury Association (ASIA) score. The three group were significantly higher than the preoperative, immediate group, early group was significantly higher than that of the conventional group, the difference was statistically significant (P<0.05), immediate group and early group, the difference was not statistically significant (P>0.05);the ESR, visual analogue scale (VAS) scores after operation in the three groups were significantly lower than those before operation, the ESR, VAS scores and recurrence rate after operation in immediate group were significantly higher than that in the early group and the normal group, the difference was statistically significant (P<0.05), the comparison of the ESR, VAS scores and recurrence rate after operation in early group and conventional group, the difference was not statistically significant (P>0.05). Conclusion Thoracic spinal cord injury in patients with tuberculosis after the timing of surgery should be based on standard anti tuberculosis treatment andthe 2-4 weeks after injury and it can effectively reduce the surgical trauma, complications and conducive to the nerve functional recovery.