摘要
目的：分析脊柱结核合并系统性红斑狼疮的围手术期特点及手术治疗疗效。方法：回顾性分析2004年9月至2012年12月北京胸科医院骨科收治的19例脊柱结核合并系统性红斑患者的临床资料。男5例,女14例,胸椎结核10例,腰椎结核5例,胸腰椎结核4例。Frankel分级：B级2例,C级3例,D级9例,E级5例。19例患者均合并一种或多种其他疾病,10例合并糖尿病,9例合并高血压,2例合并肾炎,慢性阻塞性肺疾病7例。所有患者均有手术适应证并手术清除病灶。14例采用后路椎板切开减压病灶清除并内固定术,5例采用后路内固定、前路病灶清除术。结果：19例患者均获得随访。随访时间12~36个月,平均22个月,围手术期均无狼疮活动,4例刀口出现积液等,经切开引流换药后愈合佳;1例停药1年后复发,脓肿再次形成,经调整抗结核药物并二次手术后愈合,1例因骨质疏松内固定松动取出内固定。末次随访植骨均获融合,末次随诊Frankel分级明显改善,C级1例,D级3例,E级15例。VAS评分由术前（8.1±1.2）分到末次随访（2.4±0.8）分,明显改善。结论：脊柱结核合并系统性红斑狼疮患者,对其他疾病相应处理,术中及术后3天内需要加大激素用量,可以耐受手术治疗。如结核药物使用规范、合理、手术入路选择合理,病灶清除、内固定并植骨融合术可以对脊柱结核治疗有很好的疗效。
Objective： To study characteristic of peri operative period and the effect of operative treatment.Methods： Do retrospective analysis of clinical data from September 2009 to December 2012, including five male patients, fourteen female patients. Among the nineteen cases, ten of them suffered from thoracic vertebral tuberculosis, five oF them had tuberculosis of lumbar spine, and four of them had thoracic or spine tuberculosis.According to Frankel classification, the nineteen cases can be divided into four levels, two cases are in level B, three are in level C. nine are in level D, and five are in tevet E.Atl the nineteen patients sulTered from two or more diseases.Rather, ten of the patients have diabetes, nine of them have hypertension, two of them have nephritis, and seven of them have chronic obstructive pulmonary disease.All the patients had surgical indications and surgical removal of lesions. fourteen cases use the treatment called posterior decompression to clean the focus, and then meshed with internal fixation; the rest five cases are treated with internal fixation and anterior radical debridement.Results： All cases were followed up about twelve to thirty-six months （averagely twenty-two months.There was no lupus activities in peri operative period; four cases with subcutaneous fluid have healed up well by incision and drainage; one case relapsed with abscesses after medicine withdrawal for one year cured by adjusting anti-tuberculosis drugs and a second operation, one case removed internal fixation for osteoporosis.Last follow-up showed all bone graft got fusion with no loosening or breakage of instruments.Besides, Frankel levels improved obviously, as one case is in level C, two cases are in level B, fifteen are in level E.The score changed from （8.1 1,2） to （2.4 0.8）.Conclusion： Patients suffer from spinal tuberculosis complicated with systemic lupus erythematosus can tolerate surgery by adjusting the immune-suppressing drugs and corresponding handling.For example, rational using of an
出处
《中国医药导刊》
2015年第4期339-342,共4页
Chinese Journal of Medicinal Guide
基金
北京市医院管理局临床医学发展专项经费资助(ZYLX201304)
课题名称:肺外结核的诊断与治疗
关键词
脊柱结核
手术
系统性红斑狼疮
激素
免疫抑制剂
Spinal TuberCulosis
Surgical Treatment
Systemic lupus erythematosus
Hormone
Immunosuppressive
