关键词: 结核,脊柱, 获得性免疫缺陷综合征, 共病现象, 外科手术, 治疗结果, 回顾性研究

Abstract:

Objective To explore the clinical effect of surgical treatment for patients with spinal tuberculosis complicated with acquired immune deficiency syndrome (AIDS). Methods Retrospective analysis was used to collect clinical data of 23 patients with spinal tuberculosis complicated by AIDS who underwent surgical treatment from January 2014 to January 2018 in Chengdu Public Health Clinical Medical Center, including operation time, intraoperative blood loss, surgical complications, preoperative and final follow-up visual analogue score (VAS score), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), CD4 ⁺ T lymphocyte count, nerves functional status, as well as bone graft fusion at the last follow-up. The effects of surgical treatment for those study subjects were analyzed. Results All 23 patients successfully completed the operation, with the average operation time of (268.4±11.3) min and the average bleeding volume of (490.6±101.5) ml, and without surgical incision infection. All cases were followed up. The VAS score at the last follow-up was significantly lower than that before surgery (1.0±0.7 vs. 8.2±0.6, t=6.15, P=0.001), and the pain was distinctly improved compared with that before surgery. The nerve function of 4 patients with neurological impairment before surgery completely recovered to normal. After antituberculosis treatment and surgical treatment, the ESR and CRP of the patients at the last follow-up were (9.3±2.6) mm/1 h and (4.8±1.2) mg/L, respectively, which were obviously lower than those before surgery ((79.4±4.6) mm/1 h and (57.5±5.9) mg/L), with the statistically significant differences (t=64.66, P=0.000; t=47.73, P=0.000, respectively). After perioperative management and subsequent comprehensive treatment with highly active anti-retroviral therapy, the CD4 ⁺ T lymphocyte count ((267.5±38.5) cells/μl) was increased at the last follow-up compared with preoperative count ((233.3±41.1) cells/μl), with the statistically significant difference (t=-36.57, P=0.001). All patients with bone graft fusion conformed to the Bridwell Ⅰ-Ⅱ standards. The median time of bone graft fusion was 6 months, and no internal fixator rupture was observed during follow-up. Two patients developed epilepsy 1 day after operation, 5 patients had atelectasis and high fever after operation, 11 patients had abdominal distension after operation, and all of them returned to normal after symptomatic treatment. Conclusion By strengthening perioperative management and rationally choosing surgical timing, patients with spinal tuberculosis complicated by AIDS who received surgical treatment have the better clinical effects.

Key words: Tuberculosis,spinal, Acquired immunodeficiency syndrome, Comorbidity, Surgical procedures,operative, Treatment outcome, Retrospective studies