摘要
目的探讨行一期病灶清除植骨内固定术联合局部应用利福平粉剂治疗胸腰椎结核的临床疗效。方法选取2015年7月—2017年6月在徐州医科大学附属医院行一期胸腰椎结核病灶清除加植骨内固定手术的53例患者,收集临床资料进行回顾性分析。将联合局部应用利福平粉剂者设为A组,共26例;将单纯行病灶清除植骨内固定手术者设为B组,共27例。记录2组患者手术时间、手术出血量、住院时间。检测2组患者术后1、3、7、14 d的红细胞沉降率(ESR)和谷丙转氨酶(ALT)指标,门诊随访检测术后1、3、6、12、18个月时的ESR和ALT指标。比较2组患者手术前后脊柱后凸Cobb角和脊髓损伤Frankel评分。比较2组患者术后愈合情况和药物不良反应。结果2组患者手术时间、手术出血量、住院时间比较,差异无统计学意义(P>0.05)。术后1个月2组患者的ESR和ALT指标恢复至正常范围内,2组间术后ESR和ALT值比较,差异无统计学意义(P>0.05)。与术前相比,2组患者术后脊柱后凸Cobb角减小,脊髓损伤Frankel评分升高,差异有统计学意义(P<0.05)。术后A组治愈后复发率较B组更低,差异有统计学意义(P<0.05);2组术后病灶植骨融合率及融合时间比较,差异无统计学意义(P>0.05)。所有患者均未见明显药物不良反应。结论对胸腰椎脊柱结核患者行一期病灶清除植骨内固定术是治疗脊柱结核有效的手术方式,联合局部应用利福平粉剂可以降低局部复发率,且操作安全方便,具有一定的临床应用价值。
Objective To investigate the clinical effectiveness of one-stage debridement,bone graft and internal fixation combined with local application of rifampicin powder in the treatment of thoracic and lumbar tuberculosis.Methods A total of 53 patients who underwent one-stage thoracic and lumbar tuberculosis focus removal and bone grafting and internal fixation in the Affiliated Hospital of Xuzhou Medical University from July 2015 to June 2017 were enrolled and their clinical data were retrospectively analyzed.Then,26 patients who were locally treated with rifampicin powder were set as group A,while another 27 patients who received tuberculosis focus removal and bone grafting and internal fixation were set as group B.Both groups were compared for surgical duration,blood loss during surgery and the length of hospitalization.Their erythrocyte sedimentation rate(ESR)and ALT values 1,3,7 and 14 days after surgery were detected,and their ESR and ALT values 1,3,6,12 and 18 months after surgery were determined during follow-up visits.Both groups were compared for Cobb angle and spinal injury Frankel scores before and after surgery.Their postoperative recovery and drug adverse reactions were recorded.Results There was no significant difference in surgical duration,blood loss during surgery and the length of hospitalization between the two groups(P>0.05).Their ESR and ALT values were in the normal range one month after surgery,and no statistical difference was found in postoperative ESR and ALT values between the two groups(P>0.05).After surgery,both groups presented remarkably reduced Cobb angle and increased spinal injury Frankel scores,compared with those before surgery(P<0.05).There was no significant difference in the fusion rate and fusion time between the two groups(P>0.05),but the recurrence rate was remarkably lower in group A than group B(P<0.05).No obvious drug adverse reactions were found in all groups.Conclusions One-stage debridement,bone grafting and internal fixation for thoracic and lumbar spinal tuberculosis patients is an effective surgical approach in the treatment of spinal tuberculosis.Combined local use of rifampicin powder can reduce local recurrence rate,which is safe and easy to perform,with certain clinical value.
作者
陈宏亮
段钢
袁峰
郭开今
钟欣
CHEN Hongliang;DUAN Gang;YUAN Feng;GUO Kaijin;ZHONG Xin(Department of Orthopedics,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Department of Orthopedics,the Second Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002;Department of Dermatology,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009)
出处
《徐州医科大学学报》
CAS
2020年第11期800-804,共5页
Journal of Xuzhou Medical University
基金
中国博士后科学基金第62批面上项目(2017M621826)。
关键词
脊柱结核
病灶清除
局部
利福平粉剂
spinal tuberculosis
focal debridement
local application
rifampicin powder
