摘要
目的探讨术前不同抗结核治疗时间对腰椎结核手术效果的影响。方法回顾性分析2015年1月至2021年1月于宝鸡市中医医院接受手术联合术前抗结核治疗的88例腰椎结核患者的临床资料,其中45例术前接受2周的四联抗结核治疗(A组),43例术前接受4周的四联抗结核治疗(B组)。比较两组患者的手术一般情况、治疗前后疼痛视觉模拟(VAS)评分、腰椎Oswestry功能障碍指数(ODI)、血沉(ESR)、C-反应蛋白(CRP)水平、影像学参数、肝肾功能指标[直接胆红素(DBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、尿素氮(BUN)、血肌酐(Scr)、血尿酸(Ua)]、术后并发症及末次随访时神经功能改善情况。结果所有患者均顺利完成手术;A组患者的住院时间为(14.39±3.10)d,明显短于B组的(16.20±3.41)d,医疗费用为(6.31±0.98)万元,明显少于B组的(7.16±1.43)万元,差异均有统计学意义(P<0.05);两组患者术后3个月的VAS评分、ODI指数、血清ESR、CRP及后凸cobb角较术前明显改善,差异均有统计学意义(P<0.05),但两组患者术后3个月的上述各项指标比较差异均无统计学意义(P>0.05);两组患者术后3个月的血清DBIL、ALT、AST、BUN、Scr、Ua水平均较术前升高,且A组患者的血清DBIL、ALT、AST、Scr、Ua水平明显低于B组,差异均有统计学意义(P<0.05);A组患者术后的总并发症发生率为8.89%,明显低于B组的30.23%,差异有统计学意义(P<0.05);两组患者末次随访时美国脊髓损伤协会(ASIA)分级中B、C、D、E级占比比较差异均无统计学意义(P>0.05)。结论腰椎结核患者术前采用四联抗结核治疗,2周与4周用药均可获得满意的治疗效果。但与4周用药比较,2周用药肝肾毒性小、不良反应少,安全性更高,能明显缩短患者住院时间,减少费用。
Objective To investigate the influence of different anti-tuberculosis treatment time before operation on surgical results of lumbar vertebral tuberculosis.Methods The clinical data of 88 patients with lumbar vertebral tuberculosis who underwent operation combined with preoperative anti-tuberculosis treatment in Baoji Hospital of Traditional Chinese Medicine from January 2015 to January 2021 were retrospectively analyzed.Among the 88 patients,45 received 2 weeks of quadruple anti-tuberculosis treatment before operation(group A),and 43 received 4 weeks of quadruple anti-tuberculosis treatment before operation(group B).The two groups were compared in terms of general surgical conditions,the Visual Analogue Scale(VAS)scores,lumbar Oswestry disability index(ODI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)level,imaging parameters,and liver and kidney function indicators[direct bilirubin(DBIL),alanine aminotransferase(ALT),aspertate aminotransferase(AST),blood urea nitrogen(BUN),serum creatinine(Scr),and blood uric acid(Ua)]before and after treatment,postoperative complications,and improvement of neurological function at the last follow-up.Results All patients successfully completed the operation.The length of hospital stay and medical costs of group A were(14.39±3.10)days and(6.31±0.98)×104 yuan,significantly shorter/lower than(16.20±3.41)days and(7.16±1.43)×104 yuan of group B(P<0.05).The VAS scores,ODI,ESR,CRP,and Cobb’s angle were significantly improved in the two groups at 3 months after operation(P<0.05),but there was no statistically significant difference between the two groups in the above indicators at 3 months after surgery(P>0.05).At 3 months after operation,serum DBIL,ALT,AST,BUN,Scr,and Ua levels in the two groups increased significantly compared with those before operation,and the levels in group A were significantly lower than those in group B,with statistically significant differences(P<0.05).The incidence of postoperative complications in group A(8.89%)was significantly lower th
作者
夏斌
卫建民
冯万立
王新刚
王小明
吕会强
XIA Bin;WEI Jian-min;FENG Wan-li;WANG Xin-gang;WANG Xiao-ming;LV Hui-qiang(Second Department of Spine,Baoji Hospital of Traditional Chinese Medicine,Baoji 721001,Shaanxi,CHINA)
出处
《海南医学》
CAS
2023年第3期335-339,共5页
Hainan Medical Journal
基金
陕西省中医药管理局科研项目(编号:2021-ZZ-LC026)。
关键词
腰椎结核
抗结核治疗
手术疗效
神经功能
术后并发症
Lumbar vertebral tuberculosis
Anti-tuberculosis treatment
Surgical results
Neurological function
Postoperative complication
