| 陈兴,鲍达,马远征,郭立新,李洪敏,黄凤山.颈椎结核耐药性观察及个体化治疗[J].脊柱外科杂志,2008,6(5):284-287. |
颈椎结核耐药性观察及个体化治疗  点此下载全文 (Fulltext) |
| 陈兴 鲍达 马远征 郭立新 李洪敏 黄凤山 |
| 100091 北京, 解放军总医院第二附属医院骨科;100091 北京, 解放军总医院第二附属医院骨科;100091 北京, 解放军总医院第二附属医院骨科;100091 北京, 解放军总医院第二附属医院骨科;全军结核病研究所;内蒙古自治区赤峰宝山医院骨科 |
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| 摘要： |
| 目的 观察颈椎结核分枝杆菌（M.TB）耐药情况；探讨颈椎结核个体化治疗方案。方法 2002年1月~2006年12月，行前路病灶清除植骨内固定手术治疗且随访1年以上的颈椎结核病例31例，均在术中取得脓液标本并经病理检查证实为颈椎结核。检测M.TB分离株对14种抗结核药的敏感性； PCR-SSCP法检测M.TB分离株耐药基因突变。术后不耐药者化疗6~9个月，耐单药者化疗12个月，耐多药者化疗18个月。随访时间为1~5年，平均3.2年。结果 总耐药率为54.8%，耐多药率为25.8%；在 M.TB耐药株中，5种耐药基因（katG，rpoB，rpsL，embB，pncA）突变率为88.1%；M.TB敏感株未检出耐药基因突变。本组切口一期愈合率为93.5%，总治愈率为96.8%。结论 颈椎M.TB产生耐药性与相应的基因突变密切相关。在个体化有效抗痨的基础上，应用病灶清除减压一期植骨内固定治疗颈椎结核，临床疗效满意。 |
| 关键词：颈椎 结核, 脊柱 结核, 抗多种药物性 内固定器 脊柱融合术 |
| Drug resistance observation and individualized treatment of cervical spinal tuberculosis Fulltext |
| CHEN Xing BAO Da MA Yuanzheng GUO Lixin LI Hongmin HUANG Fengshan |
| Department of Orthopaedics, Second Affiliated Hospital, PLA General Hospital, Beijing 100091, China;Department of Orthopaedics, Second Affiliated Hospital, PLA General Hospital, Beijing 100091, China;Department of Orthopaedics, Second Affiliated Hospital, PLA General Hospital, Beijing 100091, China;Department of Orthopaedics, Second Affiliated Hospital, PLA General Hospital, Beijing 100091, China |
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| Abstract: |
| Objective To observe the drug resistance of mycobacterium tuberculosis(M.TB), and to discuss the individualized treatment of cervical spinal tuberculosis. Methods Thirty-one cases of cervical spinal tuberculosis treated with anterior radical debridement, decompression and inter fixation from January 2002 to December 2006 were included (at least 1 year follow-up). Liquor puris were got in the operation and were confirmed by pathology. The sensitive of M.TB example for 14 kinds of antituberculotic were detected. And the mutation of drug resistance gene was detected by PCR-SSCP. Postoperative patients were dealed with 6~9 months chemo for no drug resistance, 12 months chemo for mono-drug resistance, and 18 months chemo for multi-drug resistance. The mean follow-up was 3.2 years (range 1~5 years). Results Total drug resistance rate was 54.8%, and 25.8% for multi-drug resistance. The genetic mutation rate of 5 kinds of drug resistance gene(katG,rpoB,rpsL,embB,pncA)was 88.1%, and no genetic mutation was found in sensitive samples. The rate of primary healing was 93.5%, and total rate was 96.8%. Conclusion There are intimate correlations between the M.TB drug resistance and genetic mutation. On the base of effective individual chemotherapy, a good effect can be obtained of cervical spinal tuberculosis treatment with radical debridement and inter fixation. |
| Keywords:Cervical vertebrae Tuberculosis,spinal Tuberculosis, multidrug-resistant Internal fixators Spinal fusion |
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