局部持续化疗和持续引流治疗脊柱结核的临床研究

张西峰 王岩 刘郑生 梁雨田 张伯勋 刘玉（解放军总医院骨科100853 北京市复兴路28号）
【摘要】目的：研究应用局部持续灌注冲洗引流和局部化疗治疗脊柱结核的临床疗效。方法：对1998年6月～2002年7月应用局部化疗的方法治疗23例脊柱结核患者进行回顾性分析。所有患者在全身化疗的基础上进行1、15例患者持续局部化疗加持续局部引流；2、5例单纯局部化疗；3、3例行手术病灶根治术加局部化疗。局部化疗灌注冲洗引流的时间为28±10d。全身化疗的时间9~18个月，平均12±2个月。观察病变的影像学改变情况，病灶内组织和涂片抗酸染色、血沉（ESP）。结果：23例中6例抗酸杆菌染色阳性占26.1％。所有患者的ESP在1～3月内恢复到正常。经过8个月~5年随访，所有患者局部没有窦道形成，没有发生交叉感染。2～6个月左右时X光片病灶骨桥形成。恢复活动后4例患者出现10度以内的后凸畸形。结论：早中期不合并严重畸形的脊柱结核脓肿、死骨、窦道形成和轻度神经刺激患者，接受脊柱微创持续局部灌注冲洗引流和局部化疗可以治愈，不再需要根治手术治疗。晚期畸形合并神经损伤者进行病灶切除内固定治疗后，局部化疗可以起到防止结核局部复发的作用。北京301医院骨科张西峰
关键词：脊柱结核；局部化疗；微创手术；计算机断层扫描
中图分类号 R529.2        文献标识码 A       文章编号 1004－406X（2003）－11－0656－04
第一作者简介：张西峰(1963-)，主治医师，医学博士，研究方向：脊柱外科，
Treatment of tuberculosis of the spine using persistent local chemotherapy and persistent local conduction./Zhang Xifeng, Wang Yan, Liu Zhengsheng, et al.//. The General Hospital of PLA, Orthopedic Department, Fuxing Road, Beijing, China. 100853
[Abstract] Objective: To investigate the results for treatment of spinal tuberculosis using persistent local chemotherapy and persistent local drainage. Method: Since Jun. 1998 to Jul. 2002, 23 patients who suffered from spinal tuberculosis were treated. 15 patients received persistent local chemotherapy combined with persistent local drainage; 5 persistent local chemotherapy; 3 debridement, inner fixation and persistent local chemotherapy. After operation, it was observed for acid-fast stain of smear and local tissue, erythrocyte sedimentation rate, radiology, and et al. 15 of 23 cases accepted percutaneous persistent local chemotherapy, irrigation and drainage. 5 cases received percutaneous persistent local chemotherapy. 3 cases with sever spinal deformity of 23 cases received radical surgery, inner fixation and persistent local chemotherapy., and The irrigation and drainage lasted average 28±10 days. Results: After 1-3 months, erythrocyte sedimentation rate recovered normal range. The sinus did not form after 8 months to 5 years follow-up. The bone bridge of tuberculosis focus formed at 2-6 months and began to walk freely. Among 23 patients, acid-fast stain of smear and focal tissue of 6 patients showed positive. After they moved about freely, 4 cases showed some deformity. The angles were less than 10-degree. Conclusion: The forepart and metaphase patients who suffered from abscess, sequestration, recurrence and sinus formation, and light nerve root compression received local chemotherapy did not need radical surgery. The patients have less suffering, less spending and shorter time of general chemotherapy. After radical surgery treated for severe spine deformation and nerve compression, local chemotherapy could prevent them recurrence.
Key words: Spinal tuberculosis; Chemotherapy; Minimal invasive surgery; CT
脊柱结核严重危害人类健康，发病率近年呈现升高的趋势。脊柱结核全身化疗起效慢、病程长，痊愈后往往遗留严重的晚期并发