天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (6): 614-619.doi: 10.11958/20170219

• 临床研究 • 上一篇    下一篇

经皮微创手术治疗腰椎结核的中远期疗效观察

朱何涛 1，2，朱博 1，高天阳 1，张琳 3，邓晓磊 4，张西峰 2△   

  1. 1 山西医科大学第二临床医学院（邮编 030001）；2 中国人民解放军总医院；3 中国人民解放军总医院海南分院；4 辽宁中医药 大学附属医院
  • 收稿日期:2017-02-23 修回日期:2017-05-18 出版日期:2017-06-15 发布日期:2017-07-05
  • 通讯作者: △通讯作者 E-mail: 656780949@qq.com E-mail:656780949@qq.com
  • 作者简介:朱何涛（1987），男，硕士研究生在读，主要从事脊柱疾病的微创治疗研究

The middle and long term curative effects of percutaneous minimally invasive surgical treatment on lumbar spinal tuberculosis

ZHU He-tao1,2, ZHU Bo1, GAO Tian-yang1, ZHANG Lin3, DENG Xiao-lei4, ZHANG Xi-feng2△   

  1. 1 The Second Hospital of Shanxi Medical University, Taiyuan 030001, China; 2 Department of Orthopedics, General Hospital of PLA; 3 Department of Orthopedics, General Hospital of PLA Hainan Branch; 4 The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine
  • Received:2017-02-23 Revised:2017-05-18 Published:2017-06-15 Online:2017-07-05
  • Contact: △Corresponding Author E-mail: 656780949@qq.com E-mail:656780949@qq.com

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摘要： 目的 探讨微创手术方式治疗腰椎结核的应用价值，为脊柱结核的临床治疗提供参考。方法 回顾性分 析我院自 2005 年 1 月—2014 年 12 月收治的保守治疗无效、需手术治疗的腰椎结核 252 例患者资料。在全身应用 抗结核药物化疗的基础上，根据病情严重程度分别采取不同微创治疗方式：接受经皮穿刺病灶置管单纯局部化疗（A 组）154 例；接受经皮灌注冲洗引流局部化疗（B 组）48 例；接受经皮穿刺病灶清除联合置管局部化疗（C 组）32 例；经 皮病灶清除+内固定联合置管局部化疗（D 组）18 例。记录患者术前及末次随访时血沉（ESR）、视觉模拟评分（VAS）、 Oswestry 功能障碍指数（ODI）并根据改良 MacNab 标准评价末次随访时患者总体优良率。结果 228 例获得随访，4 组失访情况分别为：A 组 15 例、B 组 5 例、C 组 2 例、D 组 2 例，总失访率 9.52%。患者随访时间 25~126 个月，平均 68（60，76）个月。214 例达到临床治愈，治疗期间所有患者均未出现逆行性感染和交叉感染等严重并发症。患者总 体术后末次随访时 ESR（7.26±3.43）mm/1 h，较术前 ESR（44.96±12.42）mm/1 h 降低（t=35.06，P=0.023）；末次随访时 总体 VAS 评分、ODI 分别为 1.5（1，3）、30（25，35）%，较术前 7.5（7.0，8.0）、60（55，65）%改善明显（Z 分别为 13.641 和 6.806，均 P＜0.05）。根据改良 MacNab 标准，末次随访时患者总体优良率 86.4%（197/228）。结论 术前综合评估腰 椎结核患者病情，依据阶梯治疗和个性化的治疗原则，通过介入或者微创的治疗方法，大多数患者可获得长期稳定 和较好的临床疗效。

关键词: 结核, 脊柱, 外科手术, 微创性, 腰椎, 抗结核药, 治疗结果, 局部化疗

Abstract: Objective To explore the application value of minimally invasive surgery in the treatment of lumbar spinal tuberculosis, and to provide reference for clinical treatment of spinal tuberculosis. Methods Data of 252 cases of patients with lumbar spinal tuberculosis treated by conservative treatment in our hospital from January 2005 to December 2014 were retrospectively analyzed. Patients were divided into four groups on the basis of systemic application of antituberculosis chemotherapy. A total of 154 patients were given simple local chemotherapy of percutaneous placement of focus catheter (group A), 48 patients were received percutaneous perfusion drainage and local chemotherapy (group B), 32 patients underwent percutaneous puncture catheter debridement combined with local chemotherapy (group C), and 18 patients were given percutaneous debridement and internal fixation combined with local chemotherapy catheter (group D). Data of erythrocyte sedimentation rate (ESR), visual analogue scale (VAS), Oswestry disability index (ODI) score and the modified MacNab criteria were recorded before operation and at the end of the follow-up in four groups of patients. Results Of the 252 patients, 228 were followed up and 214 patients achieved clinical cure. The lost access were15 cases in group A, 5 cases in group B, 2 cases in group C and 2 cases in group D. The total rate of lost visit was 9.52%. The follow up duration ranged from 25-126 months. The mean duration of follow-up was 68(60, 76) months. A total 214 cases reached the standard of clinical cure. No complications (retrograde infection and cross infection) were found in all patients during treatment. ESR was statistically decreased to (7.26±3.43) mm/1 h at the last follow-up (t= 35.06, P = 0.023) compared with that (44.96± 12.42) mm/1 h before operation. The VAS and ODI were 1.5(1, 3) and 30(25, 35)% at the last follow- up, which were significantly improved than those [7.5(7.0, 8.0) and 60(55, 65)% ] before operation (Z=13.641 and 6.806, P＜0.05). According to the improved MacNab criteria, the overall excellent and good rates for patients were 86.4% (197/228) at the last follow- up. Conclusion According to the stepped care and personalized treatment, patients of lumbar tuberculosis are preoperative comprehensive evaluated, and most patients can achieve long-term stability and a better clinical efficacy after interventional and minimally invasive treatment.

Key words: tuberculosis, spinal, surgical procedures, minimally invasive, lumbar vertebrae, antitubercular agents, treatment outcome, local chemotherapy