| 张晨威,费骏,石仕元,胡金平,赖震.脊柱结核内固定拆除术后抗结核方案的选择[J].浙江中西医结合杂志,2025,35(11): |
| 脊柱结核内固定拆除术后抗结核方案的选择 |
| Selection of Antitubercular Regimen After Removal of Internal Fixation for Spinal TuberculosisZHANG Chenwei, FEI Jun, SHI Shiyuan, HU Jinping, LAI Zhen |
| 投稿时间：2025-05-20 修订日期：2025-11-03 |
| DOI： |
| 中文关键词: 脊柱结核 内固定拆除术后 抗结核方案 结核药物毒副作用 |
| 英文关键词:Spinal tuberculosis After removal of internal fixation Antitubercular regimen Toxic side effects of antitubercular drugs |
| 基金项目:杭州市医药卫生科技项目（A20251128）；杭州市红十字会医院青年基金项目（HHQN202303） |
|
| 摘要点击次数: 66 |
| 全文下载次数: 0 |
| 中文摘要: |
| 脊柱结核作为肺外结核的常见类型，据 WHO 统计，全球每年新增结核病例约 1000 万，其中脊柱结核约占骨关节结核的 50%，且发病率呈上升趋势[1]。脊柱结核不仅造成脊柱骨质破坏、畸形，严重时压迫脊髓神经引发肢体瘫痪，还给患者家庭及社会带来沉重经济负担[2]。手术治疗在脊柱结核综合治疗中至关重要。然而，经过手术后规范抗结核治疗到内固定拆除并非治疗终点，研究表明，术后若不规范抗结核治疗，复发率可达 20% - 30%。因此，为防止原病灶及钉道内出现结核复发，对于脊柱结核术后拆除脊柱内固定的患者常予以序贯抗结核治疗。但是抗结核药物存在广泛毒副作用，涉及肝脏、胃肠道、神经系统、血液系统等多个器官系统，术后常规序贯抗结核治疗可能增加患者不良反应，影响患者治疗依从性。鉴于此，患者经历手术及术后规律抗结核治疗直至内固定拆除术后，考虑到抗结核药物的毒副作用、原病灶处可能潜伏结核菌导致结核复发情况以及患者经济负担[3]，根据脊柱结核内固定拆除术后钉道及周围组织Xpert检查结果，合理选择内固定拆除术后抗结核方案，对彻底消灭残留病菌、预防疾病复发，提升治疗效果，减轻患者痛苦及经济负担具有重大意义。本研究收集 2023 年 1 月至 2024 年 12 月浙江省中西医结合医院收治的 60 例脊柱结核术后符合内固定拆除标准的患者，旨在探讨脊柱结核内固定拆除术后抗结核方案的合理选择方式。 |
| 英文摘要: |
| Abstract:
Objective: To explore the value of formulating the anti - tuberculosis regimen after internal fixation removal for spinal tuberculosis based on the Xpert examination results of the diseased vertebrae and the tissues around the screw tracts. Methods: Sixty patients who were diagnosed with thoracolumbar spinal tuberculosis in the Department of Orthopedics of Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine from January 2023 to December 2024, underwent one - stage posterior pedicle screw internal fixation + anterior debridement, bone grafting and fusion, continued standardized anti - tuberculosis treatment for 18 months after surgery, and reached the standard for internal fixation removal to undergo spinal internal fixation removal were selected. Sixty patients who met the inclusion criteria were randomly divided into 2 groups (Group A and Group B) using a random number table, with 30 patients in each group. For patients in Group A, when removing the spinal internal fixation, the tissues in and around the screw tracts were taken for Xpert examination. According to the test results, patients in Group A were divided into: Group A1 (Xpert examination suggested positive for Mycobacterium tuberculosis) and Group A2 (Xpert examination suggested negative for Mycobacterium tuberculosis). Patients in Group A1 were given sequential anti - tuberculosis treatment for 3 months after surgery, and patients in Group A2 were not given anti - tuberculosis treatment after surgery. All patients in Group B were given sequential anti - tuberculosis treatment after internal fixation removal. In Group A, there were 19 males and 11 females, with an average age of (43.40 ± 2.19) years. In Group B, there were 17 males and 13 females, with an average age of (47.23 ± 2.42) years. The liver function (alanine aminotransferase, ALT), C - reactive protein (CRP), white blood cell count, erythrocyte sedimentation rate (ESR), and tuberculosis recurrence were compared between the two groups 3 months after surgery. Results: Three months after surgery in Group A1, alanine aminotransferase (ALT) was [(63.60 ± 33.71) U/L], white blood cell count was [(4.34 ± 1.45) × 10^9/L], C - reactive protein (CRP) was [(2.93 ± 0.60) mg/L], and erythrocyte sedimentation rate (ESR) was [(10.80 ± 6.61) mm/1h]; three months after surgery in Group A2, alanine aminotransferase (ALT) was [(23.44 ± 11.28) U/L], white blood cell count was [(6.42 ± 1.73) × 10^9/L], C - reactive protein (CRP) was [(3.01 ± 1.31) mg/L], and erythrocyte sedimentation rate (ESR) was [(12.60 ± 4.45) mm/1h]; three months after surgery in Group B, alanine aminotransferase (ALT) was [(44.33 ± 39.86) U/L], white blood cell count was [5.29 ± 1.45) × 10^9/L], C - reactive protein (CRP) was [(2.84 ± 1.14) mg/L], and erythrocyte sedimentation rate (ESR) was [(12.30 ± 4.51) mm/1h]. Three months after surgery in Group A1, 2 cases had elevated ALT and 1 case had decreased white blood cells. Three months after surgery in Group B, 6 cases had elevated ALT and 7 cases had decreased white blood cells. There was no statistically significant difference in ESR and CRP at 3 months after surgery among Group A1 and Group A2, Group A1 and Group B, and Group A2 and Group B (For the comparison between Group A1 and Group A2, the t-values were-0.786 and-0.138 respectively, and the P-values were 0.434 and 0.892 respectively; for the comparison between Group A1 and Group B, the t-values were - 0.667and 0.128 respectively, and the P - values were 0.508 and 0.880 respectively; for the comparison between Group A2 and Group B, the t-values were 0.238 and 0.531 respectively, and the P-values were 0.813 and 0.606 respectively). There was no statistically significant difference in ALT and white blood cell count at 3 months after surgery between Group A1 and Group B (For the comparison between Group A1 and Group B, the t-values were 1.300 and - 1.011 respectively, and the P-values were 0.199 and 0.315 respectively). There were statistically significant differences in ALT and white blood cell count at 3 months after surgery between Group A2 and Group A1, and between Group A2 and Group B (For the comparison between Group A2 and Group A1, the t-values were 2.671 and-2.200 respectively, and the P - values were 0.010 and 0.033 respectively; for the comparison between Group A2 and Group B, the t-values were- 2.514 and 2.140 respectively, and the P - values were 0.015 and 0.036 respectively).
Conclusion: Formulating the postoperative anti - tuberculosis regimen based on the Xpert examination results of the diseased vertebrae and the tissues around the screw tracts after internal fixation removal for spinal tuberculosis can ensure the prognosis of tuberculosis patients and reduce the toxic and side effects of anti - tuberculosis drug use. |
| 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
