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