摘要
目的:观察应用局部持续灌注冲洗引流和局部化疗治疗脊柱结核的临床疗效.方法:对1998年6月～2002年7月应用局部化疗治疗的23例脊柱结核患者进行回顾性分析.所有患者在全身化疗的基础上进行:①持续局部化疗加持续局部引流(15例);②单纯局部化疗(5例);③行手术病灶根治术加局部化疗(3例).全身化疗时间9～18个月,平均12±2个月.局部化疗灌注冲洗引流的时间为28±10d.观察病变部位影像学改变情况.结果:23例中6例抗酸杆菌染色阳性(占26.1%).ESR最高平均52.4±28.6m/h,治疗后在1～3个月内ESR均恢复正常.经过8个月～5年随访,所有患者局部无窦道形成,没有发生交叉感染.2～6个月左右X光片见病灶骨桥形成.恢复活动后4例患者出现10°以内的后凸畸形.结论:早中期不合并严重畸形的脊柱结核脓肿、死骨、窦道形成和轻度神经刺激患者,接受脊柱微创持续局部灌注冲洗引流和局部化疗可以治愈,不再需要根治手术治疗.晚期畸形合并神经损伤者进行病灶切除内固定治疗后,局部化疗可以起到防止结核局部复发的作用.
Objective:To investigate the results for treatment of spinal tuberculosis using persistent local chemotherapy and persistent local drainage.Method:Since Jun.1998to Jul.2002,23patients who suffered from spinal tuberculosis were treated.15patients received persistent local chemotherapy combined with persistent local drainage;5persistent local chemotherapy;3debridement,inner fixation and persistent local chemotherapy.After operation,it the acid-fast stain of smear and local tissue,erythrocyte sedimentation rate,radiology,and et al was observed.15of23cases accepted percutaneous persistent local chemotherapy,irrigation and drainage.5cases received percutaneous persistent local chemotherapy.3cases with sever spinal deformity received radical surgery,inner fixation and persistent local chemotherapy,and the irrigation and drainage lasted in an average of28±10days.Result:After1~3months,the erythrocyte sedimentation rate recovered to normal range.No sinus formation were found after8months to5years follow-up.The bone bridge of tuberculosis focus formed at2~6months and began to walk freely.After they freely moved,4cases showed some deformities.The angles were less than10-degree.Conclusion:The forepart and metaphase patients who suffered from abscess,sequestration,recurrence and sinus formation,and light nerve root compression received local chemotherapy need not radical surgery.These patients have less suffering,less spending and shorter time of general chemotherapy.After radical surgery treated for severe spine deformation and nerve compression,local chemotherapy could prevent them from recurrence.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2003年第11期656-659,共4页
Chinese Journal of Spine and Spinal Cord
关键词
局部持续化疗
局部持续引流
治疗
脊柱结核
临床疗效
计算机断层扫描
Spinal tuberculosis
Local chemotherapy
Minimal invasive surgery
CT[Author's address]The General Hospital of PLA,Orthopedic Department,Fuxing Road,Beijing,100853,China
