关键词: 结核,脊柱, 结核,抗多种药物性, 手术后并发症, 皮瘘, 药物疗法,联合

Abstract:

Objective To analysis the short-term efficacy of individualized chemotherapy of drug-resistant spinal tuberculosis complicated with sinus after operation. Methods 24 patients who met the inclusion criteria with drug-resistant spinal tuberculosis complicated with sinus after operation were enrolled from January 2015 to January 2017 in Xi’an Chest Hospital. Referring to the past history of anti-tuberculosis chemotherapy, the results of first-line anti-tuberculosis drug phenotype susceptibility test (referred to as “drug sensitivity test”) and the relevant chemotherapy schemes in accordance with the “Guidelines for Chemotherapy of Drug-resistant Tuberculosis (2015)”, individualized anti-tuberculosis drug treatment schemes were formulated and the effective dressing was changed regularly and the patients were followed up. There were 15 males and 9 females; aged 21-69 years, mean (41.5±12.4) years old. The healing time of tuberculous sinus were observed. The changes of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. The changes of sinus appearance and CT findings were observed. Results The healing time of the monodrug-resistant group was 18-52 days, with an average of (36.7±10.3) days. The healing time of the polydrug-resistant group was 53-96 days, with an average of (71.7±13.6) days. The healing time of the multidrug-resistant group was 68-260 days, with an average of (141.2±39.7) days. ESR and CRP were normal at the last follow-up, which were (14.6±5.5)mm/1h and (2.8±1.3) mg/L, respectively. 24 patients were followed up for 12-24 months, with an average of (19.8±4.5) months. 21 cases were healed, 3 cases were obviously improved and did not healed, but no re-formation of sinus tract and no recurrence of tuberculosis were found at the last follow-up. Conclusion According to the individualized anti-tuberculosis therapy based on drug sensitivity test and combined with the effective dressing change of sinus, the cutaneous sinus after drug-resistant spinal tuberculosis can be cured and the clinical effect is satisfactory.

Key words: Tuberculosis,spinal, Tuberculosis,multidrug-resistant, Postoperative complications, Cutaneous fistula, Drug therapy,combination