河北医科大学学报

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脊柱结核术后复治原因的临床分析研究

  

  1. 1.河北省胸科医院骨科,河北 石家庄 050041;2.河北省人民医院急诊科,河北 石家庄 050051
  • 出版日期:2016-03-25 发布日期:2016-05-11
  • 作者简介:姚黎明( 1980- ),男,河北石家庄人,河北省胸科医 院主治医师,医学硕士,从事骨科疾病诊治研究。
  • 基金资助:
    河北省科学技术研究与发展计划( 1120140287 )

Clinical study on the reasons for retreating postoperative spinal tuberculosis#br#

  1. 1.Department of Orthopedics, the Chest Hospital of Hebei Province, Shijiazhuang 050041,China;
    2.Department of  Emergency, the People′s Hospital of Hebei Province, Shijiazhuang 050051, China
  • Online:2016-03-25 Published:2016-05-11

摘要: [摘要] 目的 探讨脊柱结核术后复治的相关原因。方法 回顾性分析 23 例复治脊柱结核患者为观察组,同
期术后顺利愈合的脊柱结核患者 186 例为对照组,比较 2 组患者的临床资料,分析影响脊柱结核术后复治的相关
因素。结果 观察组术前白蛋白水平以及植骨融合、术后规范抗结核治疗、手术彻底清除病灶比例均低于对照组,
结核菌耐药、其他部位合并结核、不利条件比例均高于对照组,差异有统计学意义( P <0.01 )。 Logistic 多因素回归
分析结果表明术前白蛋白水平 <35g / L 、手术病灶清除不彻底、未行植骨融合、术后应用抗结核药物不规范、结核
菌耐药、其他部位合并结核、合并不利条件均是脊柱结核术后复治的危险因素。结论 术前积极营养支持、纠正贫
血及治疗其他部位结核,术中彻底清除病灶、病椎行植骨融合处理,术后抗结核药物规范使用、加强管理(行腰大肌
穿刺抽液注药、控制血糖)等可以减少脊柱结核的复治发生。

关键词: 结核, 脊柱, 复发, 危险因素

Abstract: [
Abstract ] Objective To summarizethe reasonsforretreating postoperative spinal
tuberculosis ( TB ) .Methods Twenty-threepatientswithpostoperativerecurrenceofspinalTB
(
observationgroup ) and186patientswithnorecurrenceofspinalTB (
controlgroup ) were
studiedretrospectively.Theclinicaldatabetweentwogroupswerecomparedandthecorrelation
factorsofretreatingspinalTBwerestatisticallyanalyzed.Results Theincidenceofnutrition ,
degreeofdebridement , graftbonefusion , postoperationalchemotherapyintheobservationgroup
werelowerthanthoseinthecontrolgroup.Theincidenceofdrugresistance , TBatotherparts ,
adverseconditionsintheobservationgroupweresignificantlyhigherthanthoseinthecontrol
group ( P <0.01 ) .Multiplelogisticregressionanalysisrevealedthatpreoperativeserumalbumen
level ( <35g / L ), nothavingstandardizedpostoperationalchemotherapy , nothavingcompletely
debridement , withoutfusion , drugresistance , TBatotherpartsandadverseconditionswerethe
riskfactorsofretreatingpostoperativespinalTB.Conclusion Theearlyandpositivetherapies
(
nutritionalsupportandanemiacorrection ), strengtheningtheanti-TBtreatmentatotherparts ,
complete debridement for lesions , graft bone fusion , standardized anti-TB treatment ,
strengtheningthepostoperativemanagement ( psoaspuncturewithdrewedeffusionandinjected
drug , controlofbloodglucose
) shouldbehelpfultoreduceretreatingrateofpostoperativespinal
tuberculosis.

Key words: tuberculosis, spinal , recurrence , riskfactor