手术治疗脊柱结核病灶清除术后感染的疗效

Efficacy analysis of reoperation for postoperative spinal tuberculosis with complicated infection

中文关键词:  脊柱结核术后  重度感染  手术治疗

英文关键词:Spinal tuberculosis  Severe infection  Reoperation  Curative effect

中文摘要:

  【摘要】 目的：探讨手术治疗脊柱结核病灶清除术后合并感染的疗效分析。方法：回顾性分析2006年1月~2018年12月在我院骨科收治的因脊柱结核术后感染而再次手术的患者的资料18例，其中男性11例，女性7例，年龄27~76岁，平均46.6±18.3岁，随访12~36个月，平均18.6±6.5个月，统计合并症、首次手术方式、致病菌种类、手术时间、术中出血量、术后植骨融和情况等资料，统计手术前、术后2周以及末次随访Cobb角以及C反应蛋白（C-reactive protein，CRP）、血沉、疼痛视觉模拟评分（visual analogue scale，VAS）；根据美国脊髓损伤协会损伤分级（American Spinal Injury Association，ASIA）分析患者手术前及末次随访时的截瘫程度的变化，综合上述因素，评价手术治疗脊柱结核术后感染的疗效分析及相关风险。结果：18例患者中，感染金黄色葡萄球菌4例，大肠埃希菌3例，肺炎克雷伯菌2例，表面葡萄球菌2例，溶血性葡萄球菌2例，厌氧菌1例，铜绿假单胞菌1例，阴沟肠杆菌1例；鲍曼不动杆菌2例。14例采取了单纯后路手术，4例采取了前后路联合的手术。手术时间为97～280min，出血量为100～1200ml。患者术前血沉45.6±25.8mm/h，CRP为38.3±42.0mg/L，VAS评分为6.3±1.5分，Cobb角为15.3°±6.7°；术后2周时血沉30.3±11.0mm/h，CRP为24.1±8.9mg/L，VAS评分2.4±1.2分，Cobb角12.6°±5.8°；末次随访血沉14.2±9.6mm/h，CRP为11.6±13.2mg/L，VAS评分为1.8±1.1分，Cobb角12.8°±4.7°，均有统计学差异（P＜0.05）。1例ASIA B级患者术后恢复至D级、1例ASIA C级患者及4例ASIA D级患者末次随访时ASIA分级达到E级；有1例ASIA D级患者术后仍评为D级，但患者疼痛等症状明显恢复，生活基本自理。术后3～5个月植骨融合率100%。所有患者再次术后未见明显并发症。结论：脊柱结核术后感染的患者，经过充分抗感染、手术中彻底清除病灶、术后充分引流后，也能取得很好的治疗效果。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy and related risks of reoperation for spinal tuberculosis patients with severe infection after focal debridement. Methods: Retrospectively analyzed data of 18 patients who underwent revision surgery after focal debridement due tospinal tuberculosis infection from January 2006 to December 2018 in Beijing chest hospital affiliated to the Capital University of Medical Sciences. There were a total of 11 males and 7 females, aged 27-76(46.6±18.3) years. The follow up time ranged from 12 to 36 months, averaged 18.6±6.5 months. Complications, operation method, bacteria species, operation time, intraoperative blood loss, fusion status, Cobb angle changes preoperatively, 2 weeks after surgery and at the last follow-up were measured. Visual analogue scale(VAS), C-reactive protein, and erythrocyte deposition rate were also collected. Paraplegia status preoperatively and at the last follow-up were assessed using the American Spinal Injury Association(ASIA) injury scale. The surgical outcome and associated risks were then analyzed. Results: Among the 18 patients, 4 were infected with Staphylococcus aureus, 3 Escherichia coli, 2 Klebsiella pneumoniae, 2 Staphylococcus superficial, 2 Staphylococcus hemolyticus, 1 anaerobe, 1 Pseudomonas aeruginosa, 1 Enterobacter cloacae, and 2 Acinetobacter baumannii. 14 cases underwent posteriorsurgery and 4 underwent combined anterior and posterior surgery. Operation time ranged from 97 to 280 minutes and bleeding volume ranged from 100 to 1200ml. The patients were followed up for 12 to 36 months, with an average of 22 months. At 3 to 5 months after the operation, the fusion rate of bone graft was 100%. There were no obvious complications after reoperation in all patients. The average preoperative ESR was 45.6±25.8mm/h, CRP was 38.3±42.0mg/L, VAS score was 6.3±1.5, and Cobb angle was 15.3°±6.7°. At 2 weeks postoperatively, the mean values of those parameters were 30.3±11.0mm/h, 24.1±8.9mg/L, 2.4±1.2, and 12.6°±5.8°, respectively. At the final follow-up they were 14.2±9.6mm/h, 11.6±13.2mg/L, 1.8±1.1, and 12.8°±4.7°, respectively(P＜0.05). One ASIA grade B patient recovered to grade D after surgery, one ASIA grade C patient and four ASIA grade D patients reached grade E at the final follow-up. There was one case of ASIA D remained the status after the surgery. Conclusions: In patients with severe infection after spinal tuberculosis, reoperation canresult in good therapeutic outcome.