关键词: 结核, 脊柱, 手术后并发症, 脓肿, 导管, 留置, 引流术, 治疗结果

Abstract:

Objective To evaluate the outcome and application value of debridement of local lesions combined with catheter irrigation and drainage in treating postoperative abscess in patients with thoracolumbar tuberculosis.Methods This was a retrospective study of 41 thoracolumbar tuberculosis patients with postoperative abscess who were admitted to the Department of Orthopedics, the Chest Hospital of Hebei Province from January 2014 to December 2017, including 25 males and 16 females. There were 13 cases of thoracic tuberculosis and 28 cases of lumbar tuberculosis. Among them, 23, 41, 18 and 26 patients were complicated by psoas abscess, paraspinal abscess, sinus and subcutaneous abscess, respectively. All patients underwent local incision and debridement of abscesses combined with catheter irrigation and drainage. After intraoperative incision of abscesses, the lesions were removed and then the catheter was placed. Irrigation was continued for 6 to 23 days after surgery. Regular follow-up was performed to observe or determine incision healing, abscesses re-occurrence, red blood cell sedimentation rate (ESR) level, C-reactive protein (CRP) level, visual analogue scale (VAS) score, bone graft fusion and improvement in clinical symptoms.Results The time of debridement of local lesions combined with catheter irrigation and drainage ranged from 20 to 45 minutes in the 41 patients, with an average of (30.0±13.2) minutes. The bleeding volume ranged from 20 to 100 ml, with an average of (40.0±16.3) ml. No significant spinal cord, blood vessel or nerve injury occurred. In one patient, the sinus was re-appeared after removal of the catheter. After dressing and re-drainage, the incision healed well. In other cases, the incisions healed in one-stage surgery without the occurrence of delayed incision healing and sinus. No paraspinal, psoas or subcutaneous abscesses re-occurred after removal of the catheter. The ESR was (24.32±9.34) mm/1 h three weeks after surgery and (40.46±19.75) mm/1 h before surgery; the difference was statistically significant (t=8.43, P<0.05). The CRP was (13.41±6.20) mg/L three weeks after surgery and (20.56±10.00) mg/L before surgery; the difference was statistically significant (t=7.91, P<0.05). The average VAS score was (1.93±1.27) three weeks after surgery, which was statistically lower compared with (6.68±1.95) before surgery (t=16.79, P<0.05). All patients achieved bone fusion within 6 to 12 months after surgery. Conclusion For patients with abscesses after spinal tuberculosis surgery, debridement of local lesions combined with catheter irrigation and drainage shows advantages of timely removal of the lesions and adequate drainage and can reduce the occurrence of pus and the progression of lesions, standing for an effective method for complicated abscesses after spinal tuberculosis surgery.

Key words: Tuberculosis, spinal, Postoperative complications, Abscess, Catheters, indwelling, Drainage, Treatment outcome