46例老年脊柱结核临床特点及外科治疗体会

Experience and clinical features of surgical treatment of spinal tuberculosis in 46 aged patients

目的探讨老年脊柱结核的临床特点及外科治疗策略。方法回顾分析2008年1月~2013年7月46例老年脊柱结核的病症特点以及外科治疗和术后相关的并发症。结果 43例患者获得系统随访,随访时间18~36个月,平均24个月,1例术后早期术口发生混合感染,2例分别在术后3个月、7个月出现窦道形成,1例在术后6个月出现内固定钢板螺钉松脱。其余患者经规范化疗后,结核症状无复发,植骨处均融合,内固定无松动及断裂。19例合并不同程度脊髓神经功能损伤的患者术后均得到不同程度恢复。按脊柱结核的治愈标准,治愈率为93.5%(43/46)。结论老年脊柱结核多合并其他系统疾病,区域病灶多为广泛溶骨样破坏。依据其不同的临床特点,合理的围术期准备及恰当的手术方式是治疗成败的关键。

Objective To investigate clinical features and surgical strategy of spinal tuberculosis in aged patients. Methods Characteristics,surgical treatment and postoperative complications of spinal tuberculosis in 46 aged patients from January,2008 to July,2013 were retrospectively analyzed. Results Of all the 46 cases,43 cases were given 18 to 36 months of follow-up with an average of 24 months. The results showed that one patient had incision mixed infection in early postoperative period,two patients had sinus tracts at 3 and 7 months after operation respectively,one patient had looseness and migration of the internal plate and screw fixation 6 months after operation. However,after giving standard chemotherapy,no tuberculosis symptoms recurred in other patients,bone graft fusion was achieved,no looseness or breakage of internal fixation was found.19 patients who were associated with different levels of spinal neurological damage recovered in different degrees after operation. And cure rate was 93. 5 percent( 43 /46) according to the criterion of cure of spinal tuberculosis. Conclusion Spinal tuberculosis in aged patients are always associated with other systematic diseases,whose local lesions are wide osteolytic damage. To prepare for perioperation reasonably,and to choose appropriate surgical method base on their different clinical characteristics are the key to a successful operation.