Email Alert | RSS    帮助

中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (6): 559-564.doi: 10.19982/j.issn.1000-6621.20210733

• 论著 • 上一篇    下一篇

术前短程化疗在单节段脊柱结核前路手术患者快速康复中的疗效分析

董昭良1, 姚黎明1, 王连波1, 贾晨光1, 姚晓伟1, 刘树仁1, 刘丰胜1, 王帅2()   

  1. 1河北省胸科医院骨科,石家庄 050041
    2河北省胸科医院急诊外科,石家庄 050041
  • 收稿日期:2022-01-07 出版日期:2022-06-10 发布日期:2022-06-01
  • 通信作者: 王帅 E-mail:wangshuaiwinner@163.com
  • 基金资助:
    河北省医学科学研究课题(20191035)

Analysis of effectiveness of short-course preoperative chemotherapy in rapid recovery of patients with single-segment spinal tuberculosis anterior surgery

DONG Zhao-liang1, YAO Li-ming1, WANG Lian-bo1, JIA Chen-guang1, YAO Xiao-wei1, LIU Shu-ren1, LIU Feng-sheng1, WANG Shuai2()   

  1. 1Department of Orthopedics,the Chest Hospital of Hebei Province,Shijiazhuang 050041,China
    2Department of Emergency Surgery,the Chest Hospital of Hebei Province,Shijiazhuang 050041,China
  • Received:2022-01-07 Online:2022-06-10 Published:2022-06-01
  • Contact: WANG Shuai E-mail:wangshuaiwinner@163.com
  • Supported by:
    Hebei Province Medical Science Research Project(20191035)

摘要:

目的: 探讨术前短程化疗在单节段脊柱结核前路手术患者快速康复中的应用价值。 方法: 选择2017年6月至2019年5月河北省胸科医院骨科收治的脊柱结核患者56例,男28例,女28例,年龄21~85岁。病变节段:颈椎2例,胸椎21例,腰椎28例、腰骶椎5例。术前均给予短程化疗方案,常规给予H-R-Z-E抗结核治疗方案,用药时间1~10d,平均(6.90±1.35)d,待患者全身中毒症状有所改善,全身一般情况能耐受手术时实施手术治疗,动态观察血红细胞沉降率(ESR)和C反应蛋白(CRP)变化情况、疼痛缓解情况、神经恢复情况、骨融合情况、脊柱结核治愈率和并发症发生情况。 结果: 56例患者中,早期伤口不愈合1例,经伤口常规换药后愈合;窦道形成1例,行窦道搔刮术后,伤口愈合,其余54例伤口一期甲级愈合。术后3周ESR[(20.96±7.97)mm/1h]较术前[(40.74±14.35)mm/1h]明显下降,差异有统计学意义(t=23.198,P=0.000);术后3周CRP[(27.57±8.98)mg/L]较术前[(45.83±9.57)mg/L]明显下降,差异有统计学意义(t=8.807,P=0.000);术后3周视觉模拟量表(visual analogue scale,VAS)评分[3(2,4)分]较术前[6(6,8)分]明显下降,差异有统计学意义(Z=-6.543,P=0.000);并发神经功能损伤的患者29例,至末次随访时2例B级患者1例改善为D级,1例改善为E级;10例C级患者改善为E级8例,D级2例;17例D级患者均改善为E级。术中结核病灶结核分枝杆菌培养阳性率为44.6%(25/56),其中单耐药脊柱结核阳性率为1.8%(1/56),耐多药脊柱结核阳性率为3.6%(2/56),多耐药脊柱结核阳性率为1.8%(1/56)。术后4~11个月56例患者椎体间植骨按照Bridwell标准达到Ⅰ级率为91.1%(51/56),Ⅱ级率为8.9%(5/56)。 结论: 对于有适应证的脊柱结核,采取术前短程化疗后行前路病灶清除植骨融合内固定术是可行的。

关键词: 结核,脊柱, 术前用药法, 外科手术, 治疗结果

Abstract:

Objective: To explore the application value of preoperative short-term chemotherapy in the rapid recovery of patients taking single-segment spinal tuberculosis anterior surgery. Methods: Fifty-six patients with spinal tuberculosis treated in the Department of Orthopedics of Hebei Chest Hospital from June 2017 to May 2019 were selected, including 28 males and 28 females, aged from 21 to 85 years. The diseased segment: there were 2 cases of cervical spine, 21 cases of thoracic spine, 28 cases of lumbar spine, and 5 cases of lumbosacral spine. All patients were given short-course chemotherapy before surgery, and H-R-Z-E quadruple anti-tuberculosis drugs were given routinely lasting 1-10 days, with an average of (6.90±1.35) days. The symptoms of systemic poisoning were improved, and the general condition of the whole body could tolerate the operation. After surgery, dynamic observations of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) changes, pain relief, nerve recovery, bone fusion, spinal tuberculosis cure rate, and complications were made. Results: Of the 56 patients enrolled, 1 case did not get early wound healing, but was healed after routine dressing change; 1 case got sinus formed, and the wound healed after sinus curettage. The remaining 54 cases all had wounds healed at first stage with level A healing. ESR ((20.96±7.97)mm/1h) at the 3rd week after operation were significantly lower than that before operation ((40.74±14.35) mm/1h), and the difference was statistically significant (t=23.198, P=0.000); CRP at the 3rd week after operation ((27.57±8.98) mg/L) was significantly lower than that before operation ((45.83±9.57)mg/L), and the difference was statistically significant (t=8.807, P=0.000); visual analogue scale (VAS) scores (3 (2,4)) at the 3rd week after operation was decreased significantly compared with the score before operation (6 (6,8)), and the difference was statistically significant (Z=-6.543,P=0.000). There were 29 patients with neurological impairment. At the end of follow-up, 2 patients with grade B impairment improved to grade D and 1 improved to grade E; within 10 patients with grade C impairment, 8 cases improved to grade E, and the others improved to grade D; all 17 patients with grade D impairment got improved to grade E. The positive rate of tuberculosis bacteria culture with samples collected from tuberculosis lesions during the operation was 44.6%(25/56), of which 1.8% (1/56) were single-drug-resistant, 3.6% (2/56) were multi-drug-resistant, and 1.8% (1/56) were poly-drug-resistant. 4-11 months after operation, 91.1% (51/56) of the 56 patients with intervertebral bone grafts achieved grade Ⅰ fusion, and 8.9% (5/56) of which achieved grade Ⅱ fusion according to Bridwell standards. Conclusion: For spine tuberculosis with indications, it is feasible to take a short course of preoperative chemotherapy before anterior debridement, bone graft fusion and internal fixation.

Key words: Tuberculosis,spinal, Premedication, Surgical procedures, Treatment outcome

中图分类号: