基于数字化信息管理系统的青海地区部分脊柱结核患者随访研究

发布时间：2018-04-19 08:46

本文选题：脊柱结核 + 保守治疗　；参考：《青海大学》2017年硕士论文

【摘要】：目的:通过对脊柱结核患者治疗后定期随访观察,探讨脊柱结核患者较为合理、有效的治疗方法。材料与方法:选取2013年3月至2016年6月在青大附院脊柱外科收治的由临床表现、辅助检查确诊脊柱结核患者189例,其中男性病人96例、女性病人93例,平均年龄42.8岁(6-82岁)。患者中最短患病时间1个月,最长患病时间120个月,平均病程13.7个月。病变累及节段:颈椎8例,胸椎76例,腰椎105例。病变累及范围:单椎体病变者8例,双椎体受累者114例,三个及更多椎体受侵犯者67例。依据患者病情予以保守治疗或手术治疗,保守治疗者予以规范、联合的抗结核化疗药物,手术治疗者给予药物并辅以病灶清除植骨融合内固定手术治疗,所有患者出院后继续予以规范、联合的抗结核药物治疗。对所有患者应用数字化信息管理系统建立随访档案并进行定期的随访观察,随访时间6-30个月,平均18个月,定期复查患者ESR、CRP、相应病变部位影像学检查(X线、CT)及患者一般状况,两治疗组及治疗前后相关指标进行对比研究,评估治疗效果。结果:所有患者经治疗后全数好转离院,院外继续治疗。两种治疗方式对比,在患者年龄及疼痛症状方面无显著性差异(P0.05),但在病程、病灶范围及有无明显脊柱后凸畸形方面的差异有统计学意义(P0.05);治疗前后对比,患者疼痛症状缓解、实验室指标的变化(ESR、CRP)以及神经功能改善方面有显著差异(P0.05);所有患者中,有15例患者疗效欠佳,加用二线抗结核药物有一定疗效。结论:对于病程短、病变轻的早期脊柱结核患者,保守治疗是较为理想的选择;针对于病灶范围大、有明显后凸畸形及伴有神经损害患者,彻底的病灶清除、植骨融合内固定手术配合抗结核药物治疗效果明显;耐药脊柱结核患者,加用二线抗结核药物有一定疗效,有待进一步深入研究。
[Abstract]:Objective: to investigate the rational and effective treatment of spinal tuberculosis by following up regularly after treatment.Materials and methods: 189 patients with spinal tuberculosis were selected from March 2013 to June 2016 in the Department of Spinal surgery of Qingda affiliated Hospital, including 96 male patients and 93 female patients, with an average age of 42.8 years or 6-82 years.The shortest time was 1 month, the longest was 120 months, the average course of disease was 13.7 months.There were 8 cases of cervical vertebra, 76 cases of thoracic vertebra and 105 cases of lumbar vertebra.The extent of involvement included single vertebral lesions in 8 cases, double vertebrae involvement in 114 cases, and three or more vertebrae invasion in 67 cases.According to the patient's condition, the patient was given conservative treatment or surgical treatment, the conservative treatment was standardized, the combination of anti-tuberculosis chemotherapeutic drugs, and the surgical treatment were given drugs and combined with focus removal, bone grafting, fusion and internal fixation.All patients continue to be treated with standardized, combined anti-tuberculosis drugs after discharge.All the patients were followed up with digital information management system (DMIS) for 6 to 30 months (mean 18 months).The two treatment groups and the treatment before and after treatment related indicators were compared to evaluate the effectiveness of treatment.Results: all the patients improved after treatment and continued treatment outside hospital.There was no significant difference in age and pain symptoms between the two treatment methods (P 0.05), but there were significant differences in the course of disease, the extent of lesion and the presence or absence of obvious kyphosis.There were significant differences in the changes of laboratory indexes and the improvement of nerve function (P 0.05), 15 of all patients had poor curative effect, and the addition of second line antituberculous drugs had certain curative effect.Conclusion: conservative treatment is an ideal choice for patients with early spinal tuberculosis with short course of disease and mild lesion.The effect of bone graft fusion and internal fixation combined with antituberculous drugs is obvious. In patients with drug-resistant spinal tuberculosis, the addition of second-line antituberculous drugs has a certain curative effect, which needs further study.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R529.2

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