关键词: 结核, 脊柱, 外科手术, 医学, 中国传统, 康复, 对比研究

Abstract:

Objective: To investigate the effect of traditional Chinese medicine (TCM) syndrome differentiation and treatment combined with standard anti-tuberculosis regimen on postoperative rehabilitation in patients with spinal tuberculosis. Methods: One hundred sixty patients with spinal tuberculosis admitted to Shandong Public Health Clinical Center from January 2022 to January 2024 were selected and divided into an observation group (80 patients) and a control group (80 patients) using random number table method. Both groups underwent surgical debridement, bone grafting, fusion, and internal fixation for spinal tuberculosis lesions, along with the H-R-E-Z anti-tuberculosis regimen for 2 weeks preoperatively and 18 months postoperatively. The observation group additionally received TCM syndrome differentiation and treatment. Follow-up was conducted to record changes in clinical symptoms and signs, laboratory indicators, and imaging findings before and after treatment, then clinical effectiveness and occurrences of adverse reactions were compared between the two groups. Results: All patients were followed up for 18 months. The observation group had an earlier time to getting out of bed ((5.2±2.4) days) and a shorter hospital stay ((12.5±4.3) days) compared to the control group ((8.3±3.7) days and (16.4±5.6) days), with statistically significant differences (t=-6.29, P<0.001; t=-4.94, P<0.001). However, there was no statistically significant differences in treatment costs between the observation group and control group ((33607.5±8920.7) yuan vs. (36832.2±8763.1) yuan, t=1.91, P=0.058). Except for the erythrocyte sedimentation rate index 2 weeks after surgery, postoperative visual analogue scale, Oswestry disability index, erythrocyte sedimentation rate, and C-reactive protein scores at 1 week and 2 weeks were (4.23±1.12) score, (55.43±5.12) %, (45.03±15.76) mm/1 h, (33.74±10.19) mg/L, and (3.44±0.39) score, (32.14±6.25) %, (29.51±12.08) mm/1 h, and (17.43±8.37) mg/L, all better than the control group ((5.94±1.33) score, (68.15±6.93) %, (58.64±16.31) mm/1 h, (47.53±11.30) mg/L, (4.69±1.04) score, (43.35±7.15) %, (31.94±14.24) mm/1 h, and (23.25±9.56) mg/L), with statistically significant differences (t value were -8.81, -13.21, -5.37, -8.11, -10.08, -10.55, -1.16, -4.10,P value were <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, 0.247, <0.001). At 18 months post-operation, no statistically significant differences were found in clinical cure rates between the observation group and control group (90.0% (72/80) vs. 85.0% (68/80), χ²=0.91, P=0.340). During the follow-up period, the recurrence rates in the observation group and the control group were 1.2% (1/80) vs. 5.0% (4/80), and the overall adverse reaction rates were 47.5% (38/80) vs. 65.0% (52/80), with statistically significant differences (χ²=3.88, P=0.049; χ²=5.33, P=0.021). Conclusion: Traditional Chinese medicine syndrome differentiation and treatment can promote early postoperative recovery in patients undergoing spinal tuberculosis surgery, lay foundation for long-term bone graft fusion, and simultaneously reduce recurrence rate and the incidence of treatment-related adverse reactions.

Key words: Tuberculosis, spinal, Surgical procedures, operative, Medicine, Chinese traditional, Rehabilitation, Comparative study