脊柱结核彻底病灶清除术后3～4.5个月超短程化疗方案的疗效观察

发布时间：2018-03-01 23:07

本文关键词： 脊柱结核彻底病灶清除超短程化疗疗效　出处：《中国脊柱脊髓杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的 :观察彻底病灶清除术后3~4.5个月超短程化疗方案治疗脊柱结核的疗效,探讨脊柱结核彻底病灶清除术后3~4.5个月的超短程化疗方案的可行性。方法:2003年12月~2014年12月116例彻底病灶清除术后应用3~4.5个月化疗方案治疗的脊柱结核患者,其中男60例,女56例,年龄40.98±17.09岁(3~78岁)。低热31例,盗汗47例,乏力53例,病变节段局部疼痛113例,脓肿78例,纳差、消瘦43例,神经功能障碍38例;胸腰椎后凸畸形33例,术前Cobb角28.46°±7.19°(19°~42°);病灶部位:颈椎1例,颈胸段1例,胸椎39例,胸腰段17例,腰椎48例,腰骶段9例,骶椎1例;累及单节段87例,双节段19例,3节段及以上10例。术前SHRZ四联抗结核治疗2~4周(平均3.2周)。手术均以彻底病灶清除为基础,其中前路手术37例,后前路手术70例,后路手术9例。术后化疗方案为2SHRZ/1~2.5HRZ,化疗期间全程督导化疗。术后观察临床表现、神经功能Frankel分级、病灶清除情况、植骨融合及病灶治愈情况、畸形矫正情况、血沉(ESR)、C反应蛋白(CRP)、药物不良反应情况。停药指征:(1)无脊柱结核的症状、体征,无脓肿及窦道形成;(2)ESR、CRP正常;(3)B超检查未发现与脊柱结核相关的脓肿;(4)影像学检查示病灶全部治愈,无新发病灶,植骨融合。结果:116例患者术后化疗时间3~4.5个月(3.89±0.60个月)。随访时间2~3年20例,3~5年15例,5~13年81例。停药时,116例患者无结核中毒症状,无局部疼痛及脓肿、窦道,生活及工作能力恢复,ESR、CRP均降至正常,病灶均彻底清除,植骨融合,病灶治愈。1例L4椎体结核患者术后服药4个月后治愈,于停药后6年复发,再次行前路彻底病灶清除髂骨植骨术,术后抗结核治疗24个月后治愈。33例胸腰椎后凸畸形的术后Cobb角为15.30°±5.13°(3°~25°),末次随访时为18.63°±6.06°(10°~36°),矫正率为46.2%,丢失率为11.8%,畸形矫正满意。末次随访时,神经功能Frankel分级较术前明显恢复,A级1例恢复至C级,B级1例恢复至D级,C级8例恢复至D级1例、E级7例,D级28例恢复至E级。17例出现术后化疗相关并发症。结论:在彻底病灶清除的基础上,严格把握适应证,全程督导化疗,脊柱结核术后3~4.5个月的超短程化疗方案是可行的。
[Abstract]:Objective: to observe the curative effect of ultra-short course chemotherapy for spinal tuberculosis in 3 ~ 4.5 months after radical debridement. Methods: from December 2003 to December 2014, 116 patients with spinal tuberculosis were treated with 3 ~ 4.5 months chemotherapy, including 60 males. There were 56 females (40.98 卤17.09 years old), 31 cases of low fever, 47 cases of night sweat, 53 cases of fatigue, 113 cases of local pain, 78 cases of abscess, 43 cases of anorexia, 43 cases of wasting, 38 cases of neurologic dysfunction, 33 cases of thoracolumbar kyphosis, 33 cases of thoracolumbar kyphosis. Preoperative Cobb angle was 28.46 掳卤7.19 掳19 掳(42 掳), lesion location included cervical vertebrae in 1 case, cervicothoracic segment in 1 case, thoracic vertebrae in 39 cases, thoracolumbar segment in 17 cases, lumbar vertebra in 48 cases, lumbosacral segment in 9 cases, sacral segment in 1 case, single segment in 87 cases. There were 19 cases of double segment with 3 or more segments and 10 cases. Preoperative SHRZ combined antituberculous therapy was performed for 2 weeks (mean 3. 2 weeks). All the operations were based on thorough focus clearance, including 37 cases of anterior approach and 70 cases of posterior anterior approach. The postoperative chemotherapy regimen was 2SHRZ / 1 / 2.5HRZ. the clinical manifestations, neurological function Frankel grading, lesion clearance, bone graft fusion, lesion healing, deformity correction were observed after operation. No symptoms, signs, no abscesses, no abscess and no sinus formation, no ESR-CRP normal 3) no abscess associated with spinal tuberculosis was found by B-ultrasound examination, and no abscess associated with spinal tuberculosis was found. Results the postoperative chemotherapy time of 116 patients was 3.89 卤0.60 months. The follow-up time was 2 ~ 3 years, 20 cases, 35 ~ 5 years, 15 cases, 5 ~ 13 years, 81 cases. There were no tuberculosis poisoning, no local pain and abscess, no sinus tract, no tuberculosis symptoms, no local pain, no abscess, no tuberculosis symptoms, no local pain, no abscess, no tuberculosis symptoms, no local pain, no abscess, no sinus tract, no tuberculous symptoms, no local pain and abscess. The recovery of life and working ability was reduced to normal, the lesions were completely cleared, bone graft was fused, and 1 cases of L4 vertebral tuberculosis were cured after taking medicine for 4 months, and recurred 6 years after stopping treatment. After 24 months of antituberculous treatment, 33 cases of thoracolumbar kyphosis were cured with Cobb angle of 15.30 掳卤5.13 掳/ 3 掳/ 25 掳and 18.63 掳卤6.06 掳/ 10 掳/ 36 掳/ m at the last follow-up. The correction rate was 46.2 掳and the loss rate was 11.8.The correction of the deformity was satisfactory at the last follow-up. The Frankel grade of nerve function was obviously restored to C grade and B grade 1 case to D grade C grade 8 cases to D grade 1 case to D grade 7 cases to D grade 28 cases to E grade .17 cases had postoperative chemotherapy-related complications. Conclusion: on the basis of thorough debridement, It is feasible to strictly grasp the indications, to supervise the whole course of chemotherapy, and to use ultrashort chemotherapy for 3 ~ 4.5 months after operation of spinal tuberculosis.
【作者单位】：宁夏医科大学研究生院;美国南佛罗里达大学;宁夏医科大学总医院脊柱骨科;
【基金】：宁夏回族自治区重点研发计划项目(编号:2016-25)
【分类号】：R687.3

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