术前穿刺置管冲洗引流联合手术治疗复发性脊柱结核的效果分析

Pre-operation percutaneous catheter drainage intervention combine with surgery in treating spinal tuberculosis recurrence

回顾性分析2015年1月至2017年12月昆明市第三人民医院骨科收治的20例复发性脊柱结核患者,均通过术前穿刺置管冲洗引流[平均带管时间为(17.2±3.7)d]后进行二次手术治疗。通过观察患者手术治疗情况、视觉模拟评分、切口愈合情况,以及X线、CT、MR检查结果,综合判断患者的临床治疗效果。20例患者均顺利完成手术,视觉模拟评分由穿刺置管引流前的(7.52±1.09)分降低至穿刺置管冲洗引流后的(3.11±0.28)分,二次手术升高至(4.32±0.79)分。所有患者均实现临床愈合,未发现内固定器松动、断裂,以及逆行性感染、窦道等并发症。平均随访时间(1.9±0.8)年,所有患者随访期间均未发现脊柱结核再次复发。作者认为,术前置管引流冲洗联合开放手术治疗复发性脊柱结核是一种可供选择的治疗方法。

Twenty cases of recurrent spinal tuberculosis admitted to the Department of Orthopedics of the Third People’s Hospital of Kunming City from January 2015 to December 2017 were retrospectively analyzed. All patients underwent secondary surgery after pre-operation percutaneous catheter drainage intervention (mean tube time was 17.2±3.7 days). Efficacy was assessed based on symptoms of patient, visual analogue scale score (VAS), wound healing, as well as X-ray, CT, and MRI examinations. All operations were successful. The VAS was decreased from (7.52±1.09)scores to (3.11±0.28)scores after percutaneous catheter drainage intervention, and slightly increased to (4.32±0.79)scores after the secondary surgery. All patients achieved clinical healing. No loosening or rupture of the internal fixator occurred, as well as complications such as retrograde infection and sinus. The mean follow-up time was (1.9±0.8)years. No post-operative recurrence occurred again during the follow-up period. Pre-operation percutaneous catheter combine with surgery was an available and effective method to treat spinal tuberculosis recurrence.