脊柱结核患者下肢末端运动及感觉障碍的影响因素及其意义

Influencing Factors and Significance of Lower Extremity Motor and Sensory Impairment in Patients with Spinal Tuberculosis

【目的】探讨脊柱结核(spinal tuberculosis,STB)患者下肢末端运动及感觉障碍(lower-extremity motor or sensory deficits,LMSD)的影响因素及其意义。【方法】选择2015年1月至2018年1月共82例STB患者作为研究对象,根据有无LMSD分为LMSD组42例及无LMSD组40例。比较两组年龄、性别、症状持续时间、疾病恶化、临床症状、临床体征、影像学特征、后凸角、Oswestry功能障碍指数(Oswestry dysfunction index,ODI)和疼痛视觉模拟评分(Visual analogue score,VAS)等指标。【结果】多因素logistic回归分析结果显示年龄、疾病恶化、椎体部位和脊柱压缩是 LMSD的独立危险因素。 65例患者通过手术治疗,术后脊柱后凸角度从(26.8±9.3)°改善至(12.0±7.6)°,平均矫正度为(11.9±4.3)°,最后随访时的平均矫正损失为(1.9±1.5)°。两组患者的术前和末次ODI和VAS评分均有显著性差异(P<0.05)。【结论】伴有颈椎或腰椎受累的STB的患者中,若有疾病恶化史和脊柱受压史,往往会引起LMSD症状,应早期采取适当的治疗方案如手术,可达到彻底清创、稳定脊柱、恢复脊柱功能和防止STB的加重的效果。

【Objective】To explore the influencing factors and significance of lower extremity motor and sensory deficits (LMSD) in patients with spinal tuberculosis (STB).【Methods】A total of 82 STB patients from January 2015 to January 2018 were selected as the study subjects. According to the presence or absence of LMSD, 42 patients were divided into LMSD group and 40 patients without LMSD group. Age, sex, duration of symptoms, deterioration of disease, clinical symptoms, clinical signs, imaging features, kyphosis angle, Oswestry dysfunction index (ODI) and visual analogue score (VAS) were compared between the two groups.【Results】Multivariate logistic regression analysis showed that age, deterioration of disease, vertebral position and spinal compression were independent risk factors for LMSD. Sixty-five patients underwent surgical treatment. The kyphosis angle improved from (26.8±9.3) degree to (12.0±7.6) degree, the average correction degree was (11.9±4.3) degree, and the average correction loss at the final follow-up was (1.9±1.5) degree. There were significant differences in preoperative and final ODI and VAS scores between the two groups (P < 0.05).【Conclusion】 Patients with spinal tuberculosis involving cervical or lumbar spine, if they have a history of disease progression and history of spinal compression, may cause symptoms such as movement disorders or sensory disturbances. Appropriate treatment options such as surgery should be used to achieve complete debridement. Sufficient stability of the spine to better restore function prevents STB from becoming worse.