摘要
目的探讨骨关节结核耐药规律、耐药菌株对骨关节结核疗效影响及临床应对措施。方法对2007—2009年临床送结核菌培养的确诊为骨关节结核患者286例进行回顾性总结分析,总结结核菌的耐药规律、了解耐药菌株对临床疗效的影响,探讨耐药菌株骨关节结核的治疗方法。结果 286例标本中,培养为人型结核分枝杆菌133例,牛型结核分枝杆菌14例,总计培养阳性147例,阳性率51.40%。阳性结果中,耐药菌株31例,耐药发生率占培养阳性的21.09%。耐药菌株中符合耐多药标准15例,占耐药菌株的48.39%。286例患者中发生术后早期骨病灶未愈5例,新发病灶4例,总计9例,其中8例为耐药结核菌感染,9例全部行二次手术治疗。1年后随访骨病灶全部愈合。结论结核菌培养及药物敏感性测定在骨关节结核诊断与治疗中有重要意义。耐多药结核菌株对骨关节结核疗效有明显影响。对耐药结核菌株感染要依据药物敏感测定报告制定个体化治疗方案。对耐药骨关节结核早期病灶未愈和新发病灶及时配合手术有助于骨病灶愈合。
Objective To investigate the characters and the influence of multi - drug resistant mycobacterium tuberculosis strain on the clinical outcomes and its countermeasures in the treatment of bone and joint tuberculosis. Methods A total of 286 cases of bone and joint tuberculosis admitted from 2007 to 2009 were analyzed retrospectively. The characters of drug resistance, the influence of drug resistant strain on the clinical outcomes and the treatment of bone and joint tuberculosis were investigated. Results Of 286 cases, tuberculosis mycobacterium strain were positive in 147 cases with positive rate of 51.4%, in which 133 cases were M. tuberculosis and 14 cases were M. bovis. In positive findings , drug resistant strain were positive in 31 cases with positive rate of 21.09% ,in which 15 stains were consistent with the standard of multi - drug resistance accounting for 48.39% of the total drug resistant strain. Five cases were unrecovered in early period after operation,4 cases were neopathy, total 9 cases in which 8 cases were infected with drug resistant strain, which were healed by the reoperations. All cases were healed in a year. Conclusion The cultivation of mycobacterium tuberculosis and the test of drug sensitivity were important for the diagnosis and treatment of bone and joint tuberculosis. Those cases with multi - drug resistant mycobacterium strain tuberculosis can influence the curative effect of bone and joint tuberculosis significantly. Based on the drug - sensibility, the therapeutic regimen should be modified and individualized. The multi - drug resistant mycobacteria tuberculosis occur in lesions of bones and joints tuberculosis, those cases must be treated with proper operation which is found helpful in raising the recovery rate.
出处
《河北医科大学学报》
CAS
2011年第3期276-279,共4页
Journal of Hebei Medical University
关键词
结核
骨关节
分枝杆菌
结核
微生物敏感性试验
tuberculosis osteoarticular
mycobacterium tuberculosis
microbial sensitivity tests
