Abstract:

Objective To explore the influencing factors of postoperative non-healing of patients with spinal tuberculosis.Methods A total of 312 patients with spinal tuberculosis admitted to the Chengdu Public Health Clinical Medical Center from January 2012 to December 2016 were included in the study. Among them, 24 were unhealed by surgery and 288 were cured. Data on gender, age, nutritional status, time from onset to visit, surgical approach, anti-tuberculosis drug treatment plan, patient compliance, spinal lesion segment, whether concurrent with other parts of the tuberculosis, drug resistance, lesion removal, internal fixed stability, duration of preoperative standard anti-tuberculosis treatment, follow-up of the whole process, assessment of anti-tuberculosis efficacy were collected. The factors that led to the non-healing after surgery were analyzed.Results In the unhealed group, patients with nonstandard anti-tuberculosis drugs, spinal lesions more than two segments, drug-resistant tuberculosis, incomplete removal of lesions, irregular follow-up of the whole process, invalid efficacy of anti-tuberculosis therapy, interval from onset to visit of longer than 12months, and posterior surgery accounted for 75.0% (18/24), 66.7% (16/24), 41.7% (10/24), 66.7% (16/24), 58.3% (14/24), 58.3% (14/24), 41.7% (10/24), and 66.6% (16/24), which were higher than those of the patients in the cured group (27.4% (79/288), 35.8% (103/288), 12.1% (35/288), 35.8% (103/288), 26.4% (76/288), 29.2% (84/288), 4.9% (14/288), and 17.7% (51/288)); the differences were statistically significant (χ ² values were 10.11, 7.19, 15.64, 8.97, 11.01, 8.75, 12.14, 12.29, all P values ＜0.05). Multivariate logistic regression analysis showed that irregular antituberculous drugs (OR (95%CI)=3.15 (1.03-9.64)), spinal lesions more than two segments (OR (95%CI)=2.52 (1.29-4.94)), drug-resistant tuberculosis (OR (95%CI)=4.31 (1.25-14.88)), incomplete removal of the lesion (OR (95%CI)=4.90 (1.39-17.27)), irregular follow-up throughout the course (OR (95%CI)=3.99 (1.39-17.27)), invalid efficacy of anti-tuberculosis therapy (OR (95%CI)=4.46 (1.34-11.84)), onset to visit interval >12months (OR (95%CI)=12.30 (2.20-68.80)), and posterior approach (OR (95%CI)=6.51 (1.77-23.91)) were the risk factors for postoperative non-healing of spinal tuberculosis patients. Conclusion Early diagnosis and treatment, standardized anti-tuberculosis program, avoiding adaptive drug resistance, choosing anterior approach as much as possible, removing the lesion thoroughly, paying attention to regular follow-up after surgery, and adjusting irrational anti-tuberculosis drug program can reduce the rate of postoperative non-healing of tuberculosis.

Key words: Tuberculosis, spinal, Surgical procedures, operative, Treatment failure, Factor analysis, statistical