关键词: 结核, 脊柱/治疗, 截瘫, 康复, 治疗结果

Abstract: Objective To investigate the rehabilitation of spinal tuberculosis complicated with early-onset paraplegia, and evaluate the clinical outcome of systematic phased rehabilitation.  Methods From March 2008 to April 2013, we retrospectively analyzed 85 patients with spinal tuberculosis complicated with early-onset paraplegia. Among them, 46 patients were male, and 39 patients were female. The average age was 41.8±17.3, range from 13 to 73 years old. Based on post-operation systematic phased rehabilitation or conventional rehabilitation therapy,they were divided into two groups, the observation group (43 cases) using a phased systematic rehabilitation, that is, perioperative rehabilitation, early rehabilitation in Grade 3A hospital,the late family or Grade 2A hospital rehabilitation; control group (42 cases) received conventional rehabilitation. Functional assessment was made according to Modified Barthel Index (MBI), and motor examination was done according to American Spinal Injury Association(ASIA2000). All the patients were followed up clinically and radiologically for an average period of 36.2 (12－60) months.  Results At the final follow-up, all the patients had achieved rigid bony fusion according to X-ray and CT examination. There were no relapse patients. In the pre-operation, post-operation and final follow-up points, the VAS score were（7.9±1.2,2.3±0.4,2.2±0.5）in observational group versus (7.8±1.3,3.1±0.8,2.9±0.7）in the control group. In comparison with pre-operational point, t value for post-operation and final follow-up points in observation group were 29.031,28.752；and 19.955,21.508 in the control group;P<0.05, Cobb angles were（30.1±3.2,11.4±2.1,11.7±2.3；29.4±4.0,10.8±2.3,10.9±2.4）respectively in the pre-operation, post-operation and final follow-up points in the observation group and control group respectively. In comparison with pre-operational point, t value for post-operation and final follow-up points in observation group were 32.037，30.617; 26.125,25.702 in the control group; P<0.05. For MBI, the scores for observation group were 41.2±10.7,69.6±15.8,93.5±14.7 versus 42.3±12.6,70.5±13.9,87.1±13.2 in the control group. In comparison with pre-operational point, MBI had satisfactory improvement at post-operation and final follow-up points（t=－9.759,－18.862 in observation group; -9.741,-15.910 in the control group; P<0.05）. MBI was statistically different between groups 6 months after operation（t=2.110,P<0.05）. The neurological status began to recover 1－17 days after the surgery. From 3 months after the surgery to the final follow-up point, in observation group 36 patients recovered fully,4 patients had partial recovery, and 3 patients had no recovery. In control group 37 patients had complete recovery, 2 patients had partial recovery, and 3 patients had no recovery.  Conclusion For early-onset paraplegia, systematic phased rehabilitation had a better therapeutic effect than conventional rehabilitation.

Key words: Tuberculosis, spinal/therapy, Paraplegia, Rehabilitation, Treatment outcome