摘要
目的分析胸椎结核病变活动型合并截瘫患者手术疗效及截瘫时间对术后神经功能恢复的影响。方法回顾性分析2011年1月至2014年1月首都医科大学附属北京胸科医院骨科收治的胸椎结核病变活动型合并截瘫患者67例的术前、术后资料。随访12-28个月，平均14个月。全部患者均接受标准化疗2周以上，结核中毒症状改善后行手术治疗。统计患者术前1d、术后3周及末次随访疼痛视觉模拟评分（visual analogue scale，VAS）、Cobb角；统计截瘫时间（截瘫发生至手术治疗的时间间隔）；术前1d、末次随访神经功能[按照美国脊柱损伤协会（ASIA）2000年脊髓损伤神经学分类国际标准进行分级，简称“ASIA分级”]。采用SPSS17．0软件配对t检验，评价术后3周、末次随访时Cobb角和VAS评分与术前的差异；采用Wilcoxon秩和检验，评价末次随访ASIA分级与术前1d的差异；采用有序logistic回归，检验截瘫时间与末次随访ASIA分级的相关性。均以P〈0．05为有统计学意义。结果Cobb角术后3周为（14．92±9．12）。、末次随访为（16．45±9．18）°，较术前的（23．18±12．07）°明显改善，差异有统计学意义（t值分别为3．58和2．99，P值均〈0．05）。VAS评分术后3周为（3．42--＋0．99）分、末次随访为（1_75±0．62）分，较术前的（6．83±1．40）分明显改善，差异有统计学意义（t值分别为10．92和11．70，P值均〈0．05）。术前1dASIA评分A级3例，B级10例，C级32例，D级22例，E级0例；末次随访ASIA评分A级0例，B级0例，C级3例，D级6例，E级58例。采用Wilcoxon秩和检验，患者末次随访ASIA分级较术前1d明显改善，差异有统计学意义，Z=7．246，P〈0．05。患者截瘫时间为1～24周，平均（7．87±4．90）周。以截瘫时间和术前1dASIA分级为自变量，以末次随访ASIA分级为应变量，采用有序logistic回归分析：β=0．051，Х^2=0．269，P=0．604，患者截瘫时间与末次随访ASIA分级无相关性，P〉0．05。67例患者均获得骨性融合，术后融合时间3～6个月，平均（3．81±1．43）个月，未发现结核病复发。结论对于胸椎结核病变活动型合并截瘫患者，实施病灶清除脊髓减压内固定手术，可以获得良好的神经功能恢复、脊柱稳定性重建和结核治愈的效果。而术前截瘫时间与远期神经功能恢复无相关性。
Objective To investigate the efficacy of surgical treatment in patients with focus-active thoracic vertebral tuberculosis combined with paraplegia and the impact of paraplegia time on neurological function recovery. Methods From Jan 2011 to Jan 2014, 67 patients with focus-active thoracic vertebral tuberculosis combined with paraplegia had taken in surgical treatment in the department of orthopedics of Beijing Chest Hospital, Capital Medical University. All the patients were followed up by clinical and radiography for an average period of 14 （12--28） months. And all of them had taken in surgical treatment after received preoperative chemotherapy for more than 2 weeks, and the toxic symptom alleviated. The clinical outcomes of the surgical treatment was analyzed by visual analogue scale （VAS）, Cobb angle, paraplegia time and ASIA scale. The Cobb angle and the VAS score were analyzed by the Paired Samples t test. The Wilcoxon test was applied to analyze the differences of ASIA scale between before operation and the final follow-up. The ordinal logistic test was used to analyze the correlation of the paraple- gia time and the ASIA scale at the final follow-up. Results The Cobb angle （23.18±12.07）° had satisfactory ira-provement at 3 weeks after operation （ 14.92± 9.12）° and at the final follow-up （16.45±9.18）°, t： 3.58 and 2.99, P〈0.05. The VAS （6.83±1.40） also improved significantly at 3 weeks after operation （3.42±0.99） and at the final follow-up （1.75±40. 62）, t： 10. 92 and 11.70, P〈0. 05. The ASIA scale showed significant difference between one day before operation and the final follow-up by the Wileoxon test （A scale in 3 patients, B scale in 10 patients, C scale in 33 patients, D scale in 21 patients one day before the operation, and A scale and B scale in 0 patients, C scale in 3 patients, D scale in 6 patients, E scale in 58 patients at the final follow-up）, Z=7. 246,P〈0.05. The average paraplegia time was （7.87±4.90） （1 to 24） weeks. The final ASIA scale showed uneorrelated with the para- plegia time by the ordinal logistic test （p= 0. 051,Z2= 0. 269, P= 0. 604）. All the 67 cases had achieved rigid bony fusion, the average time was （3.81±1.43） （3 to 6） months. And there was no recurrence case. Conclusion The debridement, decompression and internal fixation surgery can achieve well clinical efficacy and recovery of neural function in the patients with focus-active thoracic vertebral tuberculosis combined with paraplegia. The paraplegia time had no significant effect on the neurological recovery.
出处
《中国防痨杂志》
CAS
2015年第3期223-229,共7页
Chinese Journal of Antituberculosis
基金
北京市科技计划课题（D141107005214002）首都医科大学附属北京胸科医院流行病研究室康万里助理研究员对本研究的统计学方面进行了具体的帮助!
关键词
结核
脊柱/外科学
胸椎
截瘫
治疗结果
Tuberculosis, spinal/surgery
Thoracic vertebral
Paraplegia
Treatment outcome
