活动型胸椎结核伴截瘫手术时机选择与临床疗效的研究

发布时间：2018-03-25 11:05

本文选题：手术时机　切入点：胸椎结核　出处：《山西医科大学》2015年硕士论文

【摘要】：目的:在胸椎结核伴截瘫患者诊疗中,分析不同手术时机对患者术后疼痛、脊髓损伤恢复情况、脊柱骨性结构改变、术后相关并发症的影响,研究活动型胸椎结核伴截瘫临床疗效与手术时机选择的关系。方法:回顾性分析2012年1月至2014年1月我院收治脊柱结核患者的临床资料,根据标准选择活动型胸椎结核伴截瘫患者28例。依照截瘫入院至接受手术时间长短分成两组:第I组共12名患者,入院抗结核治疗(HRZES)不到3天(平均2.1天)即接受手术治疗;第II组16名患者入院后接受2至6周四联(HRZE)抗结核治疗,每周复查ESR、CRP至正常或明显下降,合并症及贫血纠正后手术。采用SPSS 16.0软件分析两组患者术前、术后2周及末次疼痛程度、并发症、脊髓功能指数、脊髓残障指数、脊髓神经残损分级,研究活动型胸椎结核伴截瘫临床疗效与手术时机选择的关系。结果:所有患者术后无截瘫加重,神经功能在术后1天-3月恢复较快,随访时间14-36月(平均18.5月)。第I组7例发生术后并发症,第II组2例术后相关并发症。余患者切口均I期愈合、未见复发。两种手术时机的术后并发症行统计学检验,差别有统计学意义(P0.05),可以认为早期手术治疗组(第I组)并发症较多。患者术前、术后及末次随访Cobb角、MPQ、ODI、ASIA残损分级(组内)差别有统计学意义(P0.05),手术干预对患者脊髓功能恢复有效果;两种手术时机对患者功能恢复(组间)差别无统计学意义(P0.05),两种手术时机对于患者术后功能恢复无明确影响。结论:以规范抗结核药物治疗为基础的活动型胸椎结核伴截瘫,原则上应早期手术。早期接受手术的活动型胸椎结核伴截瘫患者术后神经功能恢复良好,术后短期并发症较多,应注意密切观察,及时处理。活动型胸椎结核伴截瘫病理机制不同于急性脊髓损伤,病情复杂的活动型胸椎结核伴截瘫患者在一定时间窗内采取合并症控制后尽早手术的个体化治疗方案,神经功能恢复好,无须急诊手术治疗。具体时间窗的制定有待于进一步研究。
[Abstract]:Objective: in the diagnosis and treatment of thoracic spinal tuberculosis with paraplegia, the effects of different operative timing on postoperative pain, recovery of spinal cord injury, changes of spinal bone structure and postoperative complications were analyzed. To study the relationship between the clinical effect of active thoracic vertebral tuberculosis with paraplegia and the choice of surgical timing. Methods: the clinical data of patients with spinal tuberculosis admitted to our hospital from January 2012 to January 2014 were analyzed retrospectively. According to the criteria, 28 patients with active thoracic spinal tuberculosis with paraplegia were selected. According to the length of admission to paraplegia, they were divided into two groups: group I (12 patients) received surgical treatment in less than 3 days (mean 2.1 days); After admission, 16 patients in group II were treated with anti-tuberculosis therapy combined with HRZE for 2 to 6 days. The levels of CRP in group II were reduced to normal or significantly lower every week, complications and anemia were corrected after operation. SPSS 16.0 software was used to analyze the two groups of patients before operation. The degree of pain, complications, spinal cord function index, spinal cord disability index, spinal cord nerve damage grade, 2 weeks and the last time after operation, To study the relationship between the clinical effect of active thoracic vertebra tuberculosis with paraplegia and the choice of surgical timing. Results: all the patients had no exacerbation of paraplegia after operation, and the neurological function recovered more quickly from one day to three months after operation. The follow-up time was 14-36 months (mean 18.5 months). Postoperative complications occurred in 7 cases in group I and 2 cases in group II. The difference was statistically significant (P 0.05), and it could be considered that there were more complications in the early operative treatment group (group I). After operation and at the last follow-up, there was a statistically significant difference in the grade of Asia lesion (P 0.05) between the patients with Cobb's angle and MPQ ODI. The effect of surgical intervention on the recovery of spinal cord function was significant. There was no significant difference in functional recovery between the two groups (P 0.05). The two operative timing had no significant effect on the postoperative functional recovery. Conclusion: the active thoracic spinal tuberculosis with paraplegia based on the standard antituberculous drug therapy. In principle, early operation should be carried out. The patients with active thoracic vertebra tuberculosis and paraplegia who received early operation recovered well after operation, and had more short-term complications after operation, so we should pay close attention to observe closely. The pathological mechanism of active thoracic vertebra tuberculosis with paraplegia is different from that of acute spinal cord injury. The recovery of neural function without emergency surgical treatment. The specific time window needs further study.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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