C形臂引导下经皮穿刺活检联合药物灌注对脊柱结核的诊治作用观察

Clinical report of diagnosis and treatment of spinal tuberculosis with percutaneous biopsy and drug perfusion under C-arm X-ray guidance

目的探讨C形臂引导下经皮穿刺活检联合抗结核药物灌注对活动期脊柱结核的临床诊治效果。方法回顾性分析2017年3月至2019年10月南京中医药大学附属南京市中西医结合医院收治的65例未接受开放手术的活动期脊柱结核患者,根据治疗方法的不同分为保守治疗组(33例)、常规治疗组(15例)和灌注治疗组(17例)。入院后三组患者均给予四联药物抗结核治疗,常规治疗组和灌注治疗组在C形臂引导下行经皮穿刺活检,灌注治疗组术中置管灌注抗结核药物。活检获得病理组织并进行病理检查、Xpert检测、普通细菌培养+药敏试验。继续抗结核治疗并进行随访观察,比较三组患者的治疗效果、用药时间及不良反应发生情况。结果所有患者均获随访,未发生交叉感染及窦道形成,均达到临床治愈。三组疗效评价、Cobb角改变、美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级及随访时间比较差异无显著性(P>0.05)。灌注治疗组用药时间、不良反应发生率低于保守治疗组和常规治疗组,差异有显著性(P<0.05)。保守治疗组因无法获取病理标本,不能明确有无利福平耐药,故存在2例误诊、误治。结论经皮穿刺活检联合药物灌注用于活动期脊柱结核具有确诊快、创伤小、疗程短、不良反应少等优势,适合诊治早期脊柱结核、全身情况较差或经济条件有限的患者,可作为脊柱结核诊疗的一种辅助方法。

Objective To investigate the clinical effect of percutaneous biopsy guided by C-arm X-ray machine combined with antituberculous drug perfusion on active spinal tuberculosis.Method 65 patients with active spinal tuberculosis admitted to our hospital from March 2017 to October 2019 were reviewed.All of the patients without open surgery were selected and randomly divided into conservative treatment group(33 cases),conventional treatment group(15 cases)and perfusion treatment group(17 cases).After admission,the patients in the three groups were treated with quadruple anti tuberculosis drugs.The conventional treatment group and perfusion treatment group underwent percutaneous biopsy under the guidance of C-arm X-ray machine,and the perfusion treatment group was perfused with antituberculosis drugs.The lesions of the biopsy were examined by pathology,Xpert and conventional bacterial culture and drug sensitivity test.The anti tuberculosis treatment was continued and followed up.The treatment effect,medication time and adverse reactions of the three groups were compared.Result All patients were followed up,no cross infection and sinus formation occurred,and all patients were clinically cured.There was no significant difference in efficacy evaluation,Cobb angle change,American Spinal Injury Association(ASIA)grade and follow-up time among the three groups(P>0.05).The medication time and the incidence of adverse reactions in the perfusion treatment group were significantly lower than those in the conservative treatment group and the conventional treatment group(P<0.05).Two cases in the conservative treatment group were misdiagnosed and mistreated because they were unable to obtain pathological specimens and determine whether rifampicin resistance existed.Conclusion Percutaneous biopsy combined with drug perfusion for active spinal tuberculosis has the advantages of rapid diagnosis,minimal invision,short course of treatment and less adverse reactions.It is suitable for early spinal tuberculosis with poor general condition or economic conditions.It can be used as an auxiliary method for the diagnosis and treatment of spinal tuberculosis.