关键词: 结核, 脊柱/外科学, 截瘫, 手术时机, 治疗结果, 老年人

Abstract: Objective To investigate the operation timing and therapeutic efficacy of the spinal tuberculosis with paraplegia in the elderly.  Methods From January 2005 to January 2013, medical records of 64 spinal tuberculosis patients with paraplegia in the elderly were analyzed retrospectively. Among them, 28 patients were male and 36 patients were female. The average age was (69.9±6.8) (60 to 82) years old. All patients were received preo-perative chemotherapy for (29.6±10.9) (14 to 56) days. Preoperative ASIA grades were B in 6 cases, C in 15 cases and D in 43 cases. The average preoperative paraplegia time was (5.4±3.3) (2 to 16) weeks. Fifty-seven patients had complications. All the factors above were analyzed whether operation timing and therapeutic effect were affected. All the statistical analyses were conducted with SPSS software(version 19.0),data presented as “x±s”.A student’s t-test was used to compared the difference of continuous measurements, and a P valve＜0.05 was considered statistically significant difference.  Results Sixty-four patients survived through the preoperative period. Thirty-seven patients had postoperative complications, 16 of 37 patients with postoperative complications were related with operation directly. The reasons of the postoperative complications were the advanced age of patients and the long-term bed rest caused by paraplegia. The average score of preoperative VAS was (7.2±1.3), and the average score of postoperative VAS was (2.2±1.2).The average improvement score of VAS was (5.0±2.3).The difference was statistically significant（t=12.270，P<0.05） after operation. The average improvement of ASIA was (1.2±0.5) grade after operation. The paraplegia did not improved in 4 cases for the spinal cord compressed before and behind. Bone grafts was fused in 61 cases. Average time of union was (4.8±1.3) (3 to 7) months. The average of preoperative Cobb angle was (33.4±11.3) degree,and the average of postoperative Cobb angle was changed to (16.1±6.7) degree.The average improvement of Cobb angle was (17.3±3.6) degree.The difference was statistically significant(t=5.248，P<0.05).The average follow-up time was (16.1±1.8) (12 to 18) months. Two patients relapsed for taking anti-tuberculosis drugs irregularly after operation.  Conclusion The operation is safety for patients with paraplegia in the elderly when preoperative chemotherapy time is ≥2 weeks, preoperative paraplegia time is shortened as possible and complications is controlled.The pain, ASIA grade and Cobb angle are improved obviously after operation.

Key words: Tuberculosis, spinal/surgery, Paraplegia, Operative time, Treatment outcome, Aged