艾滋病胸腰椎结核手术治疗与职业防护△

Surgical treatment and occupational protection for thoracolumbar tuberculosis complicated with AIDS

摘要:

［目的］评价艾滋病胸腰椎结核手术治疗效果与医护人员职业防护。［方法］2011 年 11 月—2019 年 5 月，采用后路病灶清除融合内固定术治疗艾滋病胸腰椎结核患者的 21 例。对临床结果与围手术期医护人员职业暴露资料进行分析。［结果］ 所有患者均顺利完成手术，无严重并发症。随访 （16.97±4.42） 个月，末次随访时，VAS 评分和 ASIA 神经功能评级均显著改善 （P<0.05）。影像显示所有患者均获得骨性融合，无病灶复发、内固定松动、断裂。职业暴露方面，术中共发生 5 次职业暴露，主要发生在手术器械传递以及手术缝合的过程中。暴露方式主要是针刺伤和眼部喷溅。所有职业暴露的医护人员均得到立即处理，随访 12 个月后检测均未发生感染。［结论］对艾滋病胸腰椎结核手术治疗可取得满意疗效，术中应加强手部与眼部职业暴露防护。

Abstract:

[Objective] To explore the clinical outcomes and occupational protection of surgical treatment for thoracolumbar tuberculo- sis complicated with AIDS. [Methods] From November 2011 to May 2019, 21 patients underwent debridement and instrumented fusion through posterior approach for thoracolumbar tuberculosis complicated with AIDS in our department. Clinical results and documents regard- ing to occupational exposure and protection of the medical staff were analyzed. [Results] All patients were operated on successfully without serious complications. At the latest follow-up lasted for (16.97±4.42) months, both VAS score and ASIA neurological function scales signifi- cantly improved compared with those preoperatively (P＜0.05) . In term of radiographic assessment, all the patients got bone fusion, without lesion recurrence, internal fixation loosening or fracture by the time of the latest follow-up. Regarding occupational exposure, a total of 5 ex- posures occurred during operation, mainly in the process of surgical instrument transfer and surgical suture, involving needle puncture and eye spatter. All occupationally exposed medical workers were treated immediately without the infection detected 12 months later. [Conclusion] The surgical treatment is still effective approach to thoracolumbar tuberculosis complicated with AIDS, and occupational protection, especially for the hands and eyes, should be highly lightened during the operation.