关键词: 负压伤口疗法, 结核,脊柱/治疗, 复发, 伤口愈合, 老年人

Abstract: Objective  To observe the application of negative pressure wound therapy(NPWT) by filling PVA foam for retreatment spine tuberculosis and sinus, and to evaluate the therapeutic effect in the elderly. Methods  From March 2008 to March 2011, 13 cases of elderly retreatment spine tuberculosis and sinus were treated by sinus debridement and NPWT. Mycobacterium tuberculosis isolated strains and its drug susceptible testing(DST) were identified by Lowenstein-Jensen(L-J) absolute concentration method. Individual anti-tuberculosis drug regimens were established according to the DST results. The regimen of 3HRZE/6HR for 9 months was given to patients with culture negative and the regimen of 3SHRZE/9HRE for 12 months was given to patients with mono-drug resistance. Some sensitive agents from first-line and second-line anti-tuberculosis drugs were selected to compose regimen to MDR-TB for 18 months. Follow-up plan was done in 1, 3, 6, 9 and 12 months after operation. Since then, follow-up was performed every 6 months. The clinical symptoms and signs, imaging of CT and three-dimensional reconstruction were collected during follow-up. According to Bridwell standard (divided into class Ⅰ, Ⅱ, Ⅲ and Ⅳ), the situation of bone graft fusion and wound healing were evaluated.  Results  Thirteen cases of elderly retreatment spine tuberculosis and sinus applied NPWT were healing well(according to Bridwell standard the fusions of bone graft were Ⅰ~Ⅱ level). It took about 12 to 28 days for wound completely healing. The average was 17.5 days. No relapse cases were found during the follow-up for 12 to 36 months.  Conclusion  NPWT is an important healing tool for retreatment spine tuberculosis and sinus in the elderly. The good clinical efficacy can be got using NPWT combination with individual anti-tuberculosis drug regimen.

Key words: Negative-pressure wound therapy, Tuberculosis,spinal/therapy, Recurrence, Wound healing, Aged