摘要
目的 评估保守方法治疗脊柱结核的疗效,初步探讨保守方法治疗脊柱结核的适应证.方法 总结解放军第三○九医院骨科2007年1月至2012年1月资料完整的经临床病史、体格检查、影像学和实验室检查、试验性抗结核治疗或影像引导下穿刺活检及细菌学检查确诊为脊柱结核,开始治疗时选择保守方法治疗的54例患者的临床特点、治疗方法及结果.54例患者采用口服抗结核药物治疗的方式,需要在标准化疗方案的基础上,根据症状缓解情况、实验室及影像学检查结果进行调整.抗结核治疗时间9～18个月,服药期间观察患者临床症状缓解情况,影像学检查判断病灶愈合、脊椎生理曲度改变情况,定期复查肝肾功能、血红细胞沉降率（ESR）、C反应蛋白（CRP）,根据疗效情况调整治疗疗程.随访时间1.5～5.5年,平均（3.0±0.8）年.结果 54例患者中49例患者通过保守治疗病灶愈合,其中45例局部疼痛消失,4例轻微背痛,不需服用止痛药物;49例患者中的32例X线或CT片显示椎间骨性融合,17例显示纤维愈合;49例脊柱局部后凸角度平均增加（5.5±0.8）°;47例ESR、CRP下降至正常范围（正常标准：男性ESR＜15 mm/1 h,女性＜20 mm/1 h;CRP＜5 μg/L）;18例治疗期间出现药物不良反应,通过减量或停用抗结核药物等治疗恢复正常.54例患者中5例分别因为治疗期间疼痛加重、出现神经损害症状或后凸畸形明显加重而选择手术治疗.结论 对于局部疼痛不严重、不伴畸形或神经损害、对抗结核药物敏感的脊柱结核患者,可通过保守治疗达到良好效果.
Objective To evaluate the efficacy of conservative treatment in patients with tuberculosis （TB） of the spine,and to explore the indications for non-surgical treatment of the spinal TB.Methods A prospectively study was conducted.Fifty-four patients with active TB of the spine who initially received non surgical treatment in the Orthopaedic Department of the 309th Hospital of Chinese People＇s Liberation Army from January 2007 to January 2012 were recruited in the study.The diagnosis of TB was based on clinical presentation,findings on imaging,laboratory examinations and experimental anti-TB chemotherapy.The image-guided biopsies were also performed if needed.The patients received anti TB combination drug chemotherapy for 9-18 months and the treatment durations were adapted individually according to the treatment outcomes during the follow up,such as the clinical manifestation,progress of healing of the focus and change of spinal physiological curvature.The liver function,erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） levels were tested regularly.The image-guided percutaneous catheter drainage was performed in 6 patients who had huge abscess.The follow-up duration was 1.5-5.5years,mean （3.0±0.8） years.Results Patient ages ranged 12-74 years （mean：（42.5±3.5） years）.The duration of prodromal symptoms before admission ranged 2-8 months （mean：（4.5 ± 1.2） months）.The infection was localized to a single vertebra in 2 patients,localized to 2 contiguous vertebras in 28 patients,and localized to more than 3 vertebras in 24 patients.All patients presented with abscesses,had no neurological deficits or severe back pain,the kyphotic angles were smaller than 30°.Out of 54 patients,49 patients were healed by conservative treatment with anti-TB drugs,and none of them had residual instability or neurological compromise.Among 49 patients,the local pain released in 45 patient while 4 patients only had mild back pain and no need to take analgesic drugs; bony fusion and fibro
出处
《中国防痨杂志》
CAS
2014年第8期684-690,共7页
Chinese Journal of Antituberculosis
关键词
结核
脊柱
药物疗法
抗结核药
Tuberculosis, spinal/drug therapy
Antitubercular agents
