关键词: 结核,脊柱, 胸椎, 疾病特征

Abstract:

Objective: To depict the clinical features of thoracic spinal tuberculosis patients. Methods: A total of 653 thoracic spinal tuberculosis cases diagnosed between January 2011 and December 2018 in Beijing Chest Hospital were enrolled retrospectively.The demographic characteristics,clinical features, outcomes of pathological examination and laboratory testing, and the way of surgery of the cases were investigated. Results: The median age of the enrolled patients was 49.0 (30.0,62.0) years old,the median course before the surgery was 6.0 (3.0,12.0) months. 78.1% (510/653) of them had back pain as the chief complaint and 81.0% (417/515) were diagnosed according to the pathological examination outcomes. 65.7% (429/653) of the enrolled patients came from the outside Beijing, and more aged patients (over 65 years old) were observed in local patients than in patients from outside Beijing (34.8% (78/224) vs. 14.0% (60/429);χ²=38.330,P<0.001). 91.4% (597/653) of the cases had their middle and/or lower thoracic vertebra involvement, and 69.5% (454/653) of them had 2 vertebral bodies involved, and 28.2% (184/653) had 3 or more. 83.2% (543/653) underwent operations and 18.2% (99/543) of them had postoperative complications. 30.5% (199/653) of the cases were paraplegic patients, and the median sedimentation rate of red blood cells (ESR)(35.0 (16.0,66.3) mm/1 h),anemia happening rate (36.7%, 73/199),the median duration of the operation (210.0 (168.5,250.0)) and the blood lost during the operation (600.0 (400.0,1000.0) ml) of the paraplegic patients were significantly different with these of the non-paraplegic patients (27.0 (11.0,55.5) mm/1 h, 24.7% (112/454), 201.0 (150.0,240.0) min, 500.0 (400.0,800.0) ml)(Z=-2.867,P=0.004;χ²=9.835,P=0.002; Z=-2.494,P=0.013; Z=-3.182,P<0.001). Finally, all postoperative complications recovered after treatment, 581 patients (89.0%) got better and left hospital, 61 patients (9.0%) were transferred to other medical institutions for further rehabilitation or treatment of basic diseases, 8 patients were not recovered from paraplegia (1.2%), and 3 patients died (0.5%). Conclusion: Thoracic spinal tuberculosis patients are generally at old age with long preoperative course, and 2 or more vertebral bodies of the middle and/or lower thoracic vertebra involvement are common. Pathological examination is the main way to provide evidence for diagnosis, and operation is an important means of treatment. The operation of the paraplegic patients takes longer time and is generally more complicated.

Key words: Tuberculosis,spinal, Thoracic vertebrae, Disease attributes