胸椎结核患者脊髓损伤后手术时机的选择及其对疗效的影响
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摘要
目的探讨胸椎结核患者脊髓损伤后手术时机的选择及其对疗效的影响。方法选取河西学院附属张掖人民医院骨科自2013年2月至2016年7月收治的胸椎结核合并脊髓损伤患者150例,依据脊髓损伤后手术时机分为即刻组(即刻)、早期组(抗结核治疗2～4周)、常规组(抗结核治疗>4周),每组50例,比较3组患者手术时间、术中出血量、植骨融合时间、并发症发生率、复发率、红细胞沉降率(ESR)、疼痛、神经功能情况。结果在手术时间、术中出血量、植骨融合时间方面,即刻组、早期组明显低于常规组,即刻组的并发症发生率明显低于常规组,差异均有统计学意义(P<0.05),即刻组与早期组比较,差异无统计学意义(P>0.05);在美国脊髓损伤协会(ASIA)评分方面,3组患者术后明显高于术前,即刻组、早期组明显高于常规组,差异有统计学意义(P<0.05),即刻组与早期组比较,差异无统计学意义(P>0.05);3组患者术后ESR、疼痛视觉模拟评分法(VAS)评分明显低于术前,即刻组术后ESR、VAS评分及复发率明显高于早期组、常规组,差异均有统计学意义(P<0.05),早期组与常规组术后ESR、VAS评分及复发率比较,差异无统计学意义(P>0.05)。结论胸椎结核患者脊髓损伤后手术时机的选择应在规范抗结核治疗、损伤后2～4周,可有效减少患者的手术创伤、并发症并利于神经功能恢复。
Objective To discuss the timing of surgery after thoracic spinal cord injury and its effect on curative effect in patients with thoracic spinal tuberculosis. Methods One hundred and fifty thoracic spinal tuberculosis patients with thoracic spinal cord injury were selected from February 2013 to July 2016 in Zhangye People's Hospital Affiliated to Hexi University, according to the timing of surgery after spinal cord injury were divided into immediategroup(immediate), early group(anti tuberculosis treatment 2-4 weeks), conventional group(anti tuberculosis treatment >4 weeks), 50 cases in each group.The operation time, intraoperative bleeding volume, fusion time, complication rate, recurrence rate,erythrocyte sedimentationrate(ESR), pain and nerve function were compared among the 3 groups.Results In operative time, bleeding volume, bone fusion time, instant group, early group was significantly lower than the normal group, the complication rate in early group was significantly lower than the normal group, the difference was statistically significant(P <0.05) immediate group and early group, there was no statistically significant difference(P >0.05) in the United States; Spinal Cord Injury Association(ASIA) score. The three group were significantly higher than the preoperative, immediate group, early group was significantly higher than that of the conventional group, the difference was statistically significant(P <0.05), immediate group and early group, the difference was not statistically significant(P>0.05); the ESR, visual analogue scale(VAS) scores after operation in the three groups were significantly lower than those before operation, the ESR, VAS scores and recurrence rate after operation in immediate group were significantly higher than that in the early group and the normal group, the difference was statistically significant(P<0.05), the comparison of the ESR, VAS scores and recurrence rate after operation in early group and conventional group, the difference was not statistically significant(P >0.05). Conclusion Thoracic spinal cord injury in patients with tuberculosis after the timing of surgery should be based on standard anti tuberculosis treatment andthe 2-4 weeks after injury and it can effectively reduce the surgical trauma, complications and conducive to the nerve functional recovery.
Objective To discuss the timing of surgery after thoracic spinal cord injury and its effect on curative effect in patients with thoracic spinal tuberculosis. Methods One hundred and fifty thoracic spinal tuberculosis patients with thoracic spinal cord injury were selected from February 2013 to July 2016 in Zhangye People's Hospital Affiliated to Hexi University, according to the timing of surgery after spinal cord injury were divided into immediategroup(immediate), early group(anti tuberculosis treatment 2-4 weeks), conventional group(anti tuberculosis treatment >4 weeks), 50 cases in each group.The operation time, intraoperative bleeding volume, fusion time, complication rate, recurrence rate,erythrocyte sedimentationrate(ESR), pain and nerve function were compared among the 3 groups.Results In operative time, bleeding volume, bone fusion time, instant group, early group was significantly lower than the normal group, the complication rate in early group was significantly lower than the normal group, the difference was statistically significant(P <0.05) immediate group and early group, there was no statistically significant difference(P >0.05) in the United States; Spinal Cord Injury Association(ASIA) score. The three group were significantly higher than the preoperative, immediate group, early group was significantly higher than that of the conventional group, the difference was statistically significant(P <0.05), immediate group and early group, the difference was not statistically significant(P>0.05); the ESR, visual analogue scale(VAS) scores after operation in the three groups were significantly lower than those before operation, the ESR, VAS scores and recurrence rate after operation in immediate group were significantly higher than that in the early group and the normal group, the difference was statistically significant(P<0.05), the comparison of the ESR, VAS scores and recurrence rate after operation in early group and conventional group, the difference was not statistically significant(P >0.05). Conclusion Thoracic spinal cord injury in patients with tuberculosis after the timing of surgery should be based on standard anti tuberculosis treatment andthe 2-4 weeks after injury and it can effectively reduce the surgical trauma, complications and conducive to the nerve functional recovery.
引文
[1]张君.分析胸椎结核合并脊髓损伤的手术治疗效果[J].中国实用神经疾病杂志,2017,20(7):71-73.
[2]Chandra SP,Singh A,Goyal N,et al.Analysis of changing paradigms of management in 179 patients with spinal tuberculosis over a 12-year period and proposal of a new management algorithm[J].World Neurosurg,2013,80(1-2):190-203.
[3]徐振文,罗敏,洪澜.不同时机抗结核治疗脊柱结核伴神经功能受损的疗效观察[J].中国实用神经疾病杂志,2014,17(12):94-95.
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[6]董健,李娟.脊柱结核手术时机的选择[J].中华骨科杂志,2014,34(2):247-249.
[7]Tosun B,Erdemir C,Yonga O,et al.Surgical treatment of thoracolumbartuberculosis:a retrospective analysis of autogenous grafting versusexpandable cages[J].Eur Spine J,2014,23(11):2299-2306.
[8]刘俊,尹锐,罗政,等.脊柱结核术后复发的相关因素研究[J].实用骨科杂志,2015,21(6):567-570.
[9]Tarantino R,Donnarumma P,Marruzzo D,et al.Anterior surgical approaches to the cervicothoracic junction:when to use the manubriotomy?[J].Spine J,2013,13(9):1064-1068.
[10]李勇,王海涛.38例胸椎结核并截瘫的手术治疗体会[J].中国伤残医学,2015,23(8):50-51.
[11]Li L,Xu J,Ma Y,et al.Surgical strategy and management outcomes for adjacent multiseg mental spinal tuberculosis:a retrospective study of forty-eight patients[J].Spine,2014,39(1):E40-E48.
[12]黄新,马远征,罗展鹏,等.手术时机对活动型胸椎结核伴截瘫临床疗效的影响[J].现代生物医学进展,2016,16(1):113-116.
[13]Cheung WY,Luk KD.Clinical and radiological outcomes after conservative treatment of TB spondylitis:is the 15 years’followup in the MRC study long enough[J].Eur Spine J,2013,22Suppl 4:594-602.
[14]黄凌云.不同手术时机对脊柱结核并截瘫患者疗效的对比观察[J].中国社区医师,2016,32(12):91,93.
[15]Held M,Laubscher M,Zar HJ,et al.GeneXpert polymerase chain reaction for spinal tuberculosis:an accurate and rapid diagnostic test[J].Bone Joint J,2014,96-B(10):1366-1369.
[16]兰汀隆,董伟杰,范俊,等.39例胸椎结核累及胸腔的手术时机、手术方式和疗效分析[J].中国防痨杂志,2017,39(4):342-347.
[17]Vorster MJ,Allwood BW,Diacon AH,et al.Tuberculous pleural effusions:advances and controversies[J].J Thorae Dis,2015,7(6):981-991.
[18]李雪莲,张立群,吴晓光,等.五例脊柱结核截瘫合并结核性脑膜炎患者的临床分析及手术时机对预后的影响[J].中国防痨杂志,2015,37(9):938-942.
[19]赵永.胸膜纤维板剥脱术治疗慢性结核包裹性脓胸患者的临床观察[J].航空航天医学杂志,2017,28(2):181-182.
[20]Tsai CH,Lai YC,Chang SC,et al.Video-assisted thoracoscopic surgical decortication in the elderly with thoracic empyema:five years’experience[J].J Chin Med Assoc,2016,79(1):25-28.
[2]Chandra SP,Singh A,Goyal N,et al.Analysis of changing paradigms of management in 179 patients with spinal tuberculosis over a 12-year period and proposal of a new management algorithm[J].World Neurosurg,2013,80(1-2):190-203.
[3]徐振文,罗敏,洪澜.不同时机抗结核治疗脊柱结核伴神经功能受损的疗效观察[J].中国实用神经疾病杂志,2014,17(12):94-95.
[4]胥少汀,季新民.脊柱结核合并脊髓损害及驼背[J].实用骨科学,2012,9:1602-1605.
[5]Faldini C,Di-Martino A,Borghi R,et al.Long vs.short fusions for adult lumbar degenerative scoliosis:does balance matters?[J].Eur Spine J,2015,24 Suppl 7:887-892.
[6]董健,李娟.脊柱结核手术时机的选择[J].中华骨科杂志,2014,34(2):247-249.
[7]Tosun B,Erdemir C,Yonga O,et al.Surgical treatment of thoracolumbartuberculosis:a retrospective analysis of autogenous grafting versusexpandable cages[J].Eur Spine J,2014,23(11):2299-2306.
[8]刘俊,尹锐,罗政,等.脊柱结核术后复发的相关因素研究[J].实用骨科杂志,2015,21(6):567-570.
[9]Tarantino R,Donnarumma P,Marruzzo D,et al.Anterior surgical approaches to the cervicothoracic junction:when to use the manubriotomy?[J].Spine J,2013,13(9):1064-1068.
[10]李勇,王海涛.38例胸椎结核并截瘫的手术治疗体会[J].中国伤残医学,2015,23(8):50-51.
[11]Li L,Xu J,Ma Y,et al.Surgical strategy and management outcomes for adjacent multiseg mental spinal tuberculosis:a retrospective study of forty-eight patients[J].Spine,2014,39(1):E40-E48.
[12]黄新,马远征,罗展鹏,等.手术时机对活动型胸椎结核伴截瘫临床疗效的影响[J].现代生物医学进展,2016,16(1):113-116.
[13]Cheung WY,Luk KD.Clinical and radiological outcomes after conservative treatment of TB spondylitis:is the 15 years’followup in the MRC study long enough[J].Eur Spine J,2013,22Suppl 4:594-602.
[14]黄凌云.不同手术时机对脊柱结核并截瘫患者疗效的对比观察[J].中国社区医师,2016,32(12):91,93.
[15]Held M,Laubscher M,Zar HJ,et al.GeneXpert polymerase chain reaction for spinal tuberculosis:an accurate and rapid diagnostic test[J].Bone Joint J,2014,96-B(10):1366-1369.
[16]兰汀隆,董伟杰,范俊,等.39例胸椎结核累及胸腔的手术时机、手术方式和疗效分析[J].中国防痨杂志,2017,39(4):342-347.
[17]Vorster MJ,Allwood BW,Diacon AH,et al.Tuberculous pleural effusions:advances and controversies[J].J Thorae Dis,2015,7(6):981-991.
[18]李雪莲,张立群,吴晓光,等.五例脊柱结核截瘫合并结核性脑膜炎患者的临床分析及手术时机对预后的影响[J].中国防痨杂志,2015,37(9):938-942.
[19]赵永.胸膜纤维板剥脱术治疗慢性结核包裹性脓胸患者的临床观察[J].航空航天医学杂志,2017,28(2):181-182.
[20]Tsai CH,Lai YC,Chang SC,et al.Video-assisted thoracoscopic surgical decortication in the elderly with thoracic empyema:five years’experience[J].J Chin Med Assoc,2016,79(1):25-28.