摘要
目的:探讨行椎体强化术的脊柱结核病理骨折围手术期处理方法,为脊柱结核鉴别诊断提供临床数据。方法:回顾分析2017年4月至2022年5月30例经椎体强化术的脊柱结核患者临床资料,根据治疗方法分为经脊柱后路骨水泥团块取出、减压、植骨融合术(A组),经脊柱后路减压、植骨融合术(B组),保守治疗(C组)。A组10例,男6例,女4例,年龄(68.50±6.81)岁;B组12例,男8例,女4例,年龄(67.92±5.86)岁;C组8例,男4例,女4例,年龄(65.00±7.09)岁。所有患者行抗结核药物治疗18~24个月。观察比较3组红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、结核感染T细胞斑点试验(T-SPOT.TB)、疼痛视觉模拟评分(visual analogue scale,VAS)、神经功能分级按美国脊柱损伤协会(American Spinal Injury Association,ASIA)神经功能分级,日常生活能力的评定采用改良Barthel指数(modified Barthel index,MBI)。结果:30例患者于术后3、12个月获得随访。27例术前ESR、CRP升高且T-SPOT.TB检查阳性,3例ESR、CRP均在正常范围且T-SPOT.TB检查阴性。A组治疗前VAS为(7.05±1.09)分,降低至术后12个月的(1.85±0.81)分,差异有统计学意义(P<0.05);B组术前VAS为(7.67±1.26)分,降低至术后12个月的(2.13±0.74)分,差异有统计学意义(P<0.05);C组治疗前(8.56±1.21)分,降低至治疗后12个月(3.06±1.23)分,差异有统计学意义(P<0.05)。3组ESR、CRP术后3、12个月均降至正常范围,与术前比较,差异有统计学意义(P<0.05)。术后12个月ASIA神经功能完全恢复26例,部分恢复4例。3组MBI治疗后12个月较治疗前明显改善,差异有统计学意义(P<0.05),治疗后3、12个月时A、B组优于C组,差异均有统计学意义(P<0.05)。结论:椎体楔形改变,不是原发性骨质疏松骨折的单一标签,应详细剖析临床细节,对椎体周边软组织影像改变,炎性改变应予以重视,行椎体强化术治疗前,建议常规行ESR、CRP检测及酶联免疫斑点试验,脊柱结核已行椎体强化术病例的手术治疗宜采用个体化的治疗方案。
Objective To explore the perioperative management of pathological fractures in spinal tuberculosis patients undergoing vertebral augmentation,and to provide clinical data for the differential diagnosis of spinal tuberculosis.Methods A retrospective analysis was conducted on the clinical data of 30 spinal tuberculosis patients who underwent vertebral augmentation from April 2017 to May 2022.According to the treatment methods,the patients were divided into three groups:Group A(posterior spinal approach with bone cement mass removal,decompression,and bone graft fusion),Group B(posterior spinal decompression and bone graft fusion),and Group C(conservative treatment).Group A included 10 patients(6 males and 4 females)with an average age of(68.50±6.81)years.Group B included 12 patients(8 males and 4 females)with an average age of(67.92±5.86)years.Group C included 8 patients(4 males and 4 females)with an average age of(65.00±7.09)years.All patients received anti-tuberculosis drug treatment for 18 to 24 months.The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),tuberculosis infection T-cell spot test(T-SPOT.TB),visual analogue scale(VAS)for pain,American Spinal Injury Association(ASIA)neurological function classification,and modified Barthel index(MBI)for assessing activities of daily living were observed and compared among the three groups.Results All 30 patients were followed up at 3 and 12 months postoperatively.Among them,27 patients showed elevated ESR and CRP during the preoperative period,and tested positive for T-SPOT.TB;The remaining 3 patients had normal ESR and CRP levels and negative T-SPOT.TB results.In Group A,the VAS decreased from 7.05±1.09 before treatment to 1.85±0.81 at 12 months postoperatively,with a statistically significant difference(P<0.05).In Group B,the preoperative VAS was 7.67±1.26,which decreased to 2.13±0.74 at 12 months postoperatively,showing a statistically significant difference(P<0.05).In Group C,the VAS score decreased from 8.56±1.21 before treatment to 3.06±1.23 at 12 months after treatment,with a statistically significant difference(P<0.05).The ESR and CRP levels of the three groups all returned to the normal range at 3 and 12 months postoperatively,which were significantly different from those before the operation(P<0.05).At 12 months postoperatively,26 patients achieved complete recovery of ASIA neurological function,and 4 patients achieved partial recovery.The MBI scores of the three groups at 12 months after treatment were significantly improved compared with those before treatment(P<0.05).Additionally,at 3 and 12 months after treatment,the MBI scores of Group A and Group B were superior to those of Group C,with statistically significant differences(P<0.05).Conclusion Vertebral wedge deformation is not an exclusive indicator of primary osteoporotic fractures.Clinical details should be thoroughly analyzed,and attention should be paid to the imaging changes of the soft tissues around the vertebral body and inflammatory changes.Before vertebral augmentation,routine ESR,CRP tests,and enzyme-linked immunospot assays(T-SPOT.TB)are recommended.For spinal tuberculosis cases that have already undergone vertebral augmentation,individualized surgical treatment plans should be adopted.
作者
姚晖
李大伟
陈红玉
Yao Hui;Li Dawei;Chen Hongyu(Department of Pain Treatment,Eye Hospital of China Academey of Chinese Medical Sciences,Beijing 100040,China;Department of Orthopaedics,the 8th Medical Center of Chinese PLA General Hospital,Beijing 100091,China)
出处
《中国骨伤》
2026年第2期148-153,共6页
China Journal of Orthopaedics and Traumatology
基金
国家自然科学基金面上项目(编号:81972081)
中国中医科学院眼科医院高水平中医医院项目(编号:GSP5-31)。
关键词
骨水泥
脊柱结核
椎体强化术
病理骨折
Bone cement
Spinal tuberculosis
Vertebral augmentation
Pathological fractures
