关键词: 结核, 脊柱/外科学, 截瘫, 围手术期医护

Abstract: Objective  To investigate the experience in perioperative management of spinal tuberculosis with paraplegia. Methods A retrospective analysis was conducted. The clinical information from 183 patients with spinal tuberculosis and paraplegia who stayed and got treatment at Orthopedics Department of the Beijing Chest Hospital from January 2009 to October 2014 was analyzed, including complications during perioperative period and management methods, treatment outcomes of surgical operations. Among those patients, 76 cases were male and 107 cases were female; the average age was（52.2±17.2） years old (range 2-87 years). SPSS 17.0 software was used for statistic analysis of the data related to patients’ nerve function, degree of pain and angle of kyphosis before and after operation. The t-test was used for comparisons between two groups and P<0.05 was regarded as statistically significant difference. Results One hundred and forty patients out of 183 enrolled patients had preoperative complications, mainly including pulmonary tuberculosis (65 cases), diabetes (31 cases), high blood pressure (24 cases), etc.; after operations, the common postoperative complications in patients were hypoalbuminemia (98 cases), anemia (69 cases), hypokalemia (26 cases), sinus tract (14 cases), cardiac insufficiency (9 cases), arrhythmia (6 cases), etc. All patients safely passed the perioperative period under appropriate management. In the perioperative period, nerve function of the patients were evaluated according to the International Standards for Neurological Classification of Spinal Cord Injury (revised 2011) published by the American Spinal Injury Association (ASIA), and the results showed that the nerve function in 164 patients improved 1-2 levels. All patients’ kyphosis angles were corrected satisfactory from (19.2±6.3)° (preoperative Cobb Angle) to (6.2±2.5)° (postoperation Cobb angles), and it was a significantly deference (t=6.956, P<0.05). The pain was measured by using the visual analogue scale (VAS), and the results showed a significant decrease in pain scores from preoperative values of (7.4±1.3) points to postoperative values of (2.2±0.3) points (t=8.964, P<0.05).  Conclusion Spinal tuberculosis patients with paraplegia had more complications before and after surgical operations, so it is an important guarantee of successful operations to conduct correct assessments and appropriate management in those patients during perioperative period.

Key words: Tuberculosis, spinal/surgery, Paraplegia, Perioperative care