摘要
目的探讨合并窦道形成的复发性复杂脊柱结核的复发因素及临床治疗策略。方法自1997年1月至2012年1月收治87例复杂性脊柱结核患者，对其中21例术后复发且合并窦道形成患者的相关资料进行回顾性分析。男12例，女9例；年龄22～58岁，平均38．8岁。其中15例患者结核菌培养及药敏试验提示耐药。术前排除窦道混合感染，根据脓肿的大小，一期窦道切除、病灶清除、内固定取出、前路植骨融合内固定术11例；一期病灶清除、内固定取出、植骨融合、后路植骨融合内固定术10例。结果所有患者获得随访，平均29．7个月。术后16例获得治愈，5例再次复发，再次复发率为23．8％（5／21），前路固定的复发率为18．2％（2／11），后路固定的复发率为30％（3／10）。3例经保守治疗治愈，2例再次行病灶清除术后治愈。影像学检查提示术后6个月植骨融合15例，术后9个月植骨融合4例，术后12个月植骨融合2例。术后后凸畸形纠正至平均5．7°。（2°～12°）。结论复发性复杂脊柱结核合并窦道形成的临床治疗较为棘手，复发原因主要与耐药结核菌株的出现、病灶清除不彻底、脊柱稳定性重建失败、合并其他脏器结核有关。有效的化疗，彻底的病灶清除，脊柱稳定的重建是保证手术治疗成功的关键。
Objective To explore the causes and clinical treatments of recurrent spinal tuberculosis complicated with si- nus tract. Methods There were 21 patients suffered from recurrent spinal tuberculosis complicated with sinus tract in 87 pa- tients with complicated spinal tuberculosis from January 1997 to January 2012. The dates of them were reviewed. There were 12 males and 9 females with an average age of 38.8 years （range, 22-58 years）. There were 15 patients whose tuberculosis bacterial culture and drug sensitive experiments suggested drug resistance. All patients were excluded from mixed infection of sinus before the operation. According to the range of the tuberculous abscess, 11 patients had undergone one stage sinus clearing and debride- ment, instrument removal, spinal fusion and internal fixation by anterior approach. The other 10 patients had undergone one stage anterior sinus clearing and debridement, instrument removal, bone graft and internal fixation by posterior approach. Results All patients were followed up for an average time of 29.7 months. 16 patients were recovered. 5 patients got recurrence with the rate of 23.8%（5/21 ）. The recurrence rate of anterior internal fixation was 18.2%（2/11 ）, and 30% （3/10） for posterior internal fixation. 3 patients got recovered by conservative treatment and 2 patients by re-debridement. 15 patients achieved bone fusion 6 months af- ter the operation; 4 patients achieved bone fusion 9 months after the operation; 1 patient achieved bone fusion 12 months after the operation. The kyphosis Cobb＇ angle was corrected to 5.7°（ranged from 2° to 12°）. Conclusion It is difficult for the treatment of recurrent complicated spinal tuberculosis combined with sinus tract. The causes of recurrence include drug-resistant strains of TB, uncompleted debridement, failure of spinal stability reconstruction, and combination with other organ tubeculosis. The key of suc- cessful surgical treatment includes effective chemotherapy, radical debridement and proper reconstruction of spinal stability.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2014年第2期162-170,共9页
Chinese Journal of Orthopaedics
关键词
结核
脊柱
复发
危险因素
治疗结果
Tuberculosis, Spinal
Recurrence
Risk factors
Treatment outcome
