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中国防痨杂志 ›› 2015, Vol. 37 ›› Issue (3): 256-260.doi: 10.3969/j.issn.1000-6621.2015.03.007

• 论著 • 上一篇    下一篇

手术治疗颈椎结核患者29例的临床疗效分析

石仕元 赖震 费骏 胡胜平   

  1. 310003 杭州市红十字会医院骨科
  • 收稿日期:2014-10-16 出版日期:2015-03-10 发布日期:2015-04-03
  • 通信作者: 赖震 E-mail:laizhen76@163.com

Clinical analysis of operation treatment of cervical tuberculosis (a report of 29 cases)

SHI Shi-yuan, LAI Zhen, FEI Jun, HU Sheng-ping   

  1. Department of Orthopedics, The Red Cross Hospital of Hangzhou, Hangzhou 310003, China
  • Received:2014-10-16 Online:2015-03-10 Published:2015-04-03
  • Contact: LAI Zhen E-mail:laizhen76@163.com

摘要: 目的 对29例颈椎结核患者手术治疗后进行临床疗效的评估。 方法 选取2005年1月至2012年1月杭州市红十字会医院骨科29例颈椎结核进行手术治疗的患者资料,男12例,女17例,年龄25~81岁,平均年龄(46.0±3.2)岁,其中上颈椎结核(C1~2)5例,下颈椎结核(C3~7)24例。其中有18例合并脊髓功能障碍,术前均行CT和MRI检查,显示病灶有明显的死骨和脓肿。术前给予抗结核化疗,术后观察结核中毒症状和脊髓功能的改善情况、植骨融合和病灶愈合情况。 结果 所有患者顺利完成手术,切口均一期愈合。1例患者术后2个月窦道形成,窦道经换药1个月后愈合;2例术中损伤喉返神经,出现声音嘶哑症状,经予神经营养治疗,3个月后恢复。29例患者术中均取手术标本(结核肉芽和脓肿),培养出结核分枝杆菌者5例,占17.24%(5/29)。术后随访18~36个月,18例合并脊髓功能障碍者,随访12个月时均有不同程度恢复,术前ASIA分类A级的2例患者全部恢复至C级;B级的10例患者恢复至D级3例、E级7例;C级的6例患者恢复至D级3例、E级3例。初治患者植骨平均融合时间为(4.5±0.4)个月,复治患者植骨平均融合时间为(4.7±0.6)个月。 结论 手术能够清除病灶脓液及坏死组织,能够重建脊柱稳定性,促进神经功能恢复,是治疗颈椎结核的有效方法;规范的抗结核化疗、充分的术前准备和合理的手术方式选择是治疗成功的重要保障。

关键词: 结核, 脊柱/外科学, 颈椎, 治疗结果, 回顾性研究

Abstract: Objective To evaluation of the clinical efficacy of operation for 29 patients with cervical spine tuberculosis. Methods From 2005 January to 2012 January, 29 patients with cervical tuberculosis were treated by operation treatment in department of orthopedics in the Red Cross Hospital in Hangzhou. There were male 12 cases, female 17 cases, mean age (46.0±3.2) years old(25-81 years old), upper cervical tuberculosis (C1-2) in 5 cases, lower cervical spine tuberculosis (C3-7) in 24 cases, 18 cases complicated with spinal cord dysfunction. Underwent CT and MRI examination before operation, the lesions have obvious dead bone abscess. Preoperative administration of anti-TB chemotherapy, to improve the situation, tuberculosis symptoms of poisoning and spinal cord function bone fusion and lesion healing observed after operation. Results All patients were completed the operation successfully, the wound healed in phase I, tuberculous sinus was formatted in 1 patient 2 months after operation, sinus was healed 1 month later. Two cases of recurrent laryngeal nerve injury, through to the neurotrophic treatment, hoarseness disappeared after 3 month. Operation specimens(tuberculous granuloma and abscess) were taken in 29 patients, Mycobacterium tuberculosis culture positive in 5 cases 17.24%(5/29). Postoperative follow-up was 18-36 months, 18 cases complicated with spinal cord dysfunction had different degree of recovery in 12 months follow-up. According to ASIA classification, Grade A in 2 cases recovered to grade C; B level of 10 patients recovered to grade D in 3 cases, grade E in 7 cases; C level of 6 patients recovered to grade D in 3 cases, grade E in 3 cases. The average time of bone graft fusion was (4.5±0.4) months in patients with untreated, retreatment patients bone graft fusion time was (4.7±0.6) months in average.  Conclusion Surgical operation can remove the lesion of pus and necrotic tissue, reconstruct spinal stability, and promote the recovery of neurological function. It is the effective method to treat cervical tuberculosis; Anti-TB chemotherapy standardization, sufficient preoperative and reasonable operation mode selection are an important guarantee for the success of treatment.

Key words: Tuberculosis, spinal/surgery, Cervical vertebrae, Treatment outcome, Retrospective studies