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张耀,张强,赵昌松,沈银忠,卢洪州,李太生,孙磊,李鑫,赵汝岗,蔡娟.一期后路手术治疗人类免疫缺陷病毒阳性胸腰椎结核[J].脊柱外科杂志,2018,16(4):200-205.
一期后路手术治疗人类免疫缺陷病毒阳性胸腰椎结核     点此下载全文 (Fulltext)
张耀1  张强1  赵昌松1  沈银忠2  卢洪州2  李太生3  孙磊4  李鑫1  赵汝岗1  蔡娟1
1. 首都医科大学附属北京地坛医院骨科, 北京 100015;
2. 复旦大学附属公共卫生临床中心感染科, 上海 201058;
3. 北京协和医院感染科, 北京 100032;
4. 首都医科大学附属北京地坛医院病理科, 北京 100015
基金项目:国家科技重大专项项目(2017ZX10202101)
DOI:10.3969/j.issn.1672-2957.2018.04.003
摘要点击次数: 53
全文下载次数: 27
摘要:
      目的 观察一期后路手术治疗人类免疫缺陷病毒(HIV)阳性胸腰椎结核患者的临床疗效。方法 2011年11月-2016年5月,首都医科大学附属北京地坛医院骨科采用一期后路手术治疗的13例HIV阳性胸腰椎结核患者作为观察组,选取同期性别、年龄、手术节段及手术方式相匹配的13例HIV阴性胸腰椎结核患者作为对照组。收集患者血红蛋白、白蛋白、CD4+T淋巴细胞计数、病毒载量、手术节段、手术时间、术中出血量等资料,记录术后并发症和死亡情况,并采用疼痛视觉模拟量表(VAS)评分、神经功能美国脊柱损伤协会(ASIA)分级、红细胞沉降率(ESR)、C反应蛋白(CRP)、后凸Cobb角、后凸矫正率、矫正丢失角度、融合时间等指标评估临床疗效。结果 2组患者血红蛋白、白蛋白、手术时间和术中出血量差异无统计学意义(P>0.05)。2组均未出现切口感染、慢性窦道形成、脑脊膜感染等并发症,观察组中出现脑脊液漏1例,神经根刺激症状1例,机会感染1例,伤口延迟愈合4例;对照组出现神经根刺激症状1例,伤口延迟愈合1例;2组并发症发生率差异有统计学意义(P<0.05)。观察组中出现术后并发症患者的CD4+T淋巴细胞计数、病毒载量、血红蛋白及白蛋白与未发生术后并发症的患者比较差异有统计学意义(P<0.05)。所有患者随访(31.0±12.1)个月,末次随访时未见结核复发,ESR、CRP恢复正常,2组患者植骨融合时间、末次随访VAS评分、神经功能ASIA分级、后凸矫正率、矫正丢失角度的差异无统计学意义(P>0.05)。结论 通过全面的术前评估、围手术期规范化抗病毒及抗结核治疗、术后积极预防并发症,一期后路手术治疗HIV阳性胸腰椎结核可获得满意的临床疗效。
关键词:胸椎  腰椎  结核,脊柱  HIV  清创术  脊柱融合术  内固定器
One-stage posterior approach for treatment of positive human immunodeficiency virus thoracolumbar tuberculosis    Fulltext
ZHANG Yao1  ZHANG Qiang1  ZHAO Chang-song1  SHEN Yin-zhong2  LU Hong-zhou2  LI Tai-sheng3  SUN Lei4  LI Xin1  ZHAO Ru-gang1  CAI Juan1
1. Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
2. Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201058, China;
3. Department of Infectious Disease, Peking Union Medical College Hospital, Beijing 100032, China;
4. Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Fund Project:
Abstract:
      Objective To investigate the efficacy of one-stage posterior approach debridement,interbody fusion and internal fixation for positive human immunodeficiency virus(HIV) thoracolumbar tuberculosis. Methods From November 2011 to May 2015,13 HIV-positive thoracolumbar spinal tuberculosis patients were enrolled in observation group. In the same period,13 HIV-negative thoracolumbar spinal tuberculosis patients were selected as the control group matched with the gender,age,surgical segment and surgical method. The age,gender,hemoglobin(HB),albumin,CD4+ T cell counts,viral load,surgical segment,operation time and intraoperative blood loss were recorded for all the patients. The postoperative complications were compared between HIV-positive patients and HIV-negative patients. The erythrocyte sedimentation rate,C-reactive protein,visual analogue scale(VAS) score,American Spinal Injury Association(ASIA) classification for neurological function,kyphosis Cobb's angle,correction rate and loss angle were compared between observation group and control group. Results There was no significant difference in age,gender,HB,albumin,operation time and intraoperative blood loss between 2 groups(P>0.05). No incision infection,chronic sinus formation and meningeal infection were found in 2 groups. In observation group,there were cerebrospinal fluid leakage in 1 patient,nerve root irritation in 1,opportunistic infection in 1 and delayed healing in 4. In control group,there were nerve root irritation in 1 and delayed healing in 1. There was a significant difference in the rate of postoperative complications between 2 groups(P<0.05). CD4+ T,viral load,HB and albumin were significantly different between the patients with and without postoperative complications in observation group(P<0.05). At the final follow-up,there was no statistically significant difference between observation group and control group in bone fusion time,VAS score,neurological function ASIA classification,kyphosis Cobb's angle correction rate and loss angle(P>0.05). Conclusion Through reasonable preoperative evaluation,optimal perioperative treatment and appropriate surgical method could significantly reduce the occurrence of complications and obtain good clinical therapeutic effect in HIV-positive thoracolumbar spinal tuberculosis patients.
Keywords:Thoracic vertebrae  Lumbar vertebrae  Tuberculosis,spinal  HIV  Debridement  Spinal fusion  Internal fixators
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