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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (8): 838-842.doi: 10.3969/j.issn.1000-6621.2019.08.007

• 论著 • 上一篇    下一篇

16例脊柱结核并发艾滋病患者的手术治疗效果分析

赵永杰,钱南平()   

  1. 475000 郑州,河南省传染病医院骨结核科
  • 收稿日期:2019-03-13 出版日期:2019-08-10 发布日期:2019-08-13
  • 通信作者: 钱南平 E-mail:290649148@qq.com

Analysis of surgical treatment of 16 patients with spinal tuberculosis combined with AIDS

Yong-jie ZHAO,Nan-ping QIAN()   

  1. Department of Bone Tuberculosis, He’nan Provincial Infectious Disease Hospital, Zhengzhou 475000, China
  • Received:2019-03-13 Online:2019-08-10 Published:2019-08-13
  • Contact: Nan-ping QIAN E-mail:290649148@qq.com

摘要:

目的 探讨和分析脊柱结核并发艾滋病(AIDS)患者手术治疗的效果。方法 采用回顾性的研究方法,选择2011年5月至2015年10月在河南省传染病医院骨结核科接受外科手术治疗的脊柱结核并发AIDS的16例患者为研究对象。其中,男10例,女6例;年龄25~74岁,平均(38.0±14.0)岁。对16例患者手术方式的选择、术中出血量、手术时间、引流管放置时间、抗结核药物治疗方案,以及术后36个月植骨融合、并发症发生及美国脊柱损伤协会(ASIA)神经功能分级(以下简称“ASIA分级”)改善情况进行分析。结果 16例患者术中出血量261~340ml,平均(300.5±30.0)ml;手术时间154~176min,平均(162.5±7.4)min;引流管放置时间4.9~7.1d,平均(6.2±0.8)d。伤口Ⅰ期愈合14例,Ⅱ期愈合2例。5例患者行超声引导下脓肿置管引流术,4例患者选择单纯前路腹膜外结核病灶清除术,2例患者采用后路椎弓根螺钉内固定+脊柱前路结核病灶清除术+髂骨取骨植骨,5例患者行脊柱椎弓根螺钉内固定+椎管内结核病灶清除+植骨术。14例患者采用6H-R-Z-E-Lfx/12H-R-E方案治疗,直至疗程结束;2例患者对利福平、异烟肼耐药,调整用药方案为6Z-E-Lfx-Am-Pto-Pa/12~18Z-E-Pto-Pa,至最终疗程结束。16例患者随访时间均超过36个月,未见内固定松动、断裂情况,无并发症出现,10例患者植骨Ⅰ级融合,5例Ⅱ级融合,1例Ⅲ级融合。ASIA分级由C级改善至D级者4例,D级改善至E级者6例,B级改善至D级者2例。结论 对于脊柱结核并发AIDS患者,根据药敏试验结果给予有效的抗结核药物治疗,选择合适的手术方式进行个体化治疗,可使患者达到良好的治疗效果。

关键词: 获得性免疫缺陷综合征, 结核,脊柱, 外科手术, 治疗结果

Abstract:

Objective To explore and analyze the effect of surgical treatment of spinal tuberculosis combined with acquired immune deficiency syndrome (AIDS).Methods A retrospective study was used to select 16 patients who underwent surgical treatment of spinal tuberculosis with AIDS in the Department of Bone Tuberculosis of He’nan Provincial Infectious Diseases Hospital from May 2011 to October 2015. Among them, there were 10 males and 6 females. The average age was (38.0±14.0) years old ranged from 25 to 74 years old. The selection of surgical methods, intraoperative bleeding, operative time, drainage tube placement time, anti-tuberculosis drug treatment regimen, and bone graft fusion after follow-up for 36 months, complications and improvement of neurological function based on the standard from the American Spinal Cord Injury Association (ASIA) were analyzed.Results The average intraoperative bleeding volume, the average operation time, the average drainage time were (300.5±30.0) ml (ranged from 261-340 ml), (162.5±7.4) min (ranged from 154-176 min) and (6.2±0.8) days (ranged from 4.9-7.1 days), respectively. The wound healing was stageⅠin 14 cases and stage Ⅱ in 2 cases. The ultrasound guided abscess drainage was performed in 5 cases, 4 cases were underwent with simple anterior extraperitoneal tuberculosis focal debridement, and 2 cases were underwent anterior spinal tuberculosis debridement, iliac bone grafting and posterior pedicle screw internal fixation. Five cases were underwent pedicle screw internal fixation, intraspinal tuberculosis debridement and bone grafting. The chemotherapy regimen with 6H-R-Z-E-Lfx/12H-R-E was used in 14 cases till the end of course and the chemotherapy regimen was changed with 6Z-E-Lfx-Am-Pto-Pa/12-18Z-E-Pto-Pa due to INH and RFP drug resistance in 2 cases till the end of course. During the follow up for 36 months, no loosening of internal fixation, fracture, no complications were found in all patients. Ten cases of Bone grafting fusion was grade Ⅰ in 10 cases, grade Ⅱ in 5 cases and grade Ⅲ in one case. ASIA grade improved from grade C to grade D in 4 cases. Grade D to E in 6 cases and grade B to grade D in 2 cases.Conclusion Effective and sufficient courses of antituberculosis drugs, appropriate surgical methods, drainage tube placement time, individual chemotherapy regimen can achieve better efficacy for patients with spinal tuberculosis combined with AIDS.

Key words: Acquired immunodeficiency syndrome, Tuberculosis,spinal, Surgical procedures,operative, Treatment outcome