胸椎结核伴截瘫患者术后神经功能恢复的影响因素

Impact factors on postoperative neurological function recovery of paraplegia secondary to thoracic tuberculosis

[目的]探讨胸椎结核伴截瘫患者手术后神经恢复的影响因素。[方法]回顾性分析2014年4月~2019年4月本中心收治的45例胸椎结核伴截瘫患者的临床资料。其中男23例,女22例,年龄17~80岁,平均(57.33±15.12)岁。术前脊髓损伤美国脊髓损伤协会分级(American Spinal Injuy Association,ASIA)A级1例,B级30例,C级4例,D级10。所有患者均行胸椎后路手术治疗。[结果]术后随访18~48个月,平均(31.80±8.12)个月。至末次随访时,23例神经功能完全恢复(complete recovery,CR),22例神经功能未完全恢复(incomplete recovery,IR)。单项因素比较表明:CR组年龄显著小于IR组(P<0.05),CR组术前瘫痪时间显著短于IR组(P<0.05),CR组术前ASIA分级轻于IR组(P<0.05),CR组影像学脊髓压迫程度显著轻于IR组(P<0.05)。二元多因素逻辑回归分析结果表明,神经功能不完全恢复的独立危险因素是高龄(OR=1.262,P=0.009)、术前瘫痪时间长(OR=1.122,P=0.014)、ASIA分级重(OR=11.494,P=0.010)、术前脊髓压迫程度重(OR=14.087,P=0.038)。[结论]影响胸椎结核伴截瘫患者术后截瘫恢复的危险因素包括术前瘫痪时间长、术前ASIA分级低、影像学脊髓压迫程度重、耐药结核。尽早手术、充分减压、矫正后凸畸形、基于药敏试验的个体化化疗对截瘫恢复具有重要意义。

[Objective]To investigate the impact factors on postoperative neurological function recovery of paraplegia secondary to thoracic tuberculosis.[Methods]A retrospective study was conducted on 45 patients who underwent surgical treatment for thoracic tuberculosis accompanied with paraplegia in our center from April 2014 to April 2019.Among them,there were 23 males and 22 females,aged between 17 and 80 years old,with an average of(57.33±15.12)years old.The preoperative ASIA classification of spinal cord injury included 1 case in grade A,30 cases in grade B,4 cases in grade C,and 10 cases in grade D.All patients were treated with posterior thoracic spine surgery.[Results]Postoperative follow-up lasted for 18~48 months,with an average of(31.80±8.12)months.At the last follow-up,23 patients got complete recovery of neurological function(CR)and 22 patients had incomplete recovery(IR).In term of univariate comparison,the age of CR group was significantly younger than that of IR group(P<0.05),the preoperative paralysis time of CR group was significantly shorter than that of IR group(P<0.05),and the preoperative ASIA grade of CR group was milder than that of IR group(P<0.05).The extent of spinal cord compression in CR group was significantly less than that in IR group(P<0.05).As results of binary multivariate logistic regression analysis,the independent risk factors for incomplete recovery of neurological function were advanced age(OR=1.262,P=0.009),preoperative paralysis time(OR=1.122,P=0.014),ASIA classification(OR=11.494,P=0.010),and preoperative spinal cord compression(OR=14.087,P=0.038).[Conclusion]The risk factors that affect the postoperative recovery of paraplegia secondary to thoracic tuberculosis include long-term preoperative paralysis,low preoperative ASIA grade,and severe spinal cord compression on images.Early surgery,adequate decompression,correction of kyphosis,and individualized chemotherapy based on drug sensitivity tests are of great significance to the recovery of paraplegia.