GATA II型胸腰椎结核抗结核治疗是否联合手术△

Anti-tuberculosis chemotherapy combined with or without pedicle screw fixation for GATA type II thoracolumbar tubercu⁃ losis

摘要:

［目的］ 对比 GATA II 型胸腰椎结核抗结核治疗是否联合手术的临床疗效。［方法］ 回顾性分析 2017 年 5 月—2019 年 7 月本院治疗 67 例胸腰椎结核患者的临床资料。其中，36 例采用单纯抗结核药物治疗（保守组），31 例采用抗结核治疗联合单纯后路手术固定（手术组）。比较两组早期、随访及辅助检查结果。［结果］治疗期间两组均无严重并发症，两组早期不良反应发生率的差异无统计学意义（P>0.05）。随访时间平均（33.35±5.23）个月。手术组完全负重活动时间显著早于保守组（P< 0.05）。术后随时间推移，两组 VAS 评分、ODI 评分、JOA 评分、ASIA 评级均显著改善 （P<0.05）。治疗后相应时间点，手术组的 ODI、JOA 评分均显著优于保守组 （P<0.05），但两组 ASIA 评级的差异均无统计学意义 （P>0.05）。手术组晚期并发症发生率显著低于保守组 （P<0.05）。辅助检查方面，术后手术组局部 Cobb 角和病灶转归显著优于保守组 （P<0.05）。治疗后 3 个月手术组 CRP、治疗后 6 个月手术组 ESR 均显著优于保守组（P<0.05）。［结论］抗结核治疗联合单纯后路内固定治疗 GATA II 型胸腰椎结核可明显缓解早期疼痛，缩短康复周期，避免后凸畸形的发生，其临床效果显著优于单纯抗结核治疗。

Abstract:

[Objective] To compare the clinical outcomes of anti-tuberculosis chemotherapy combined with or without pedicle screw fixation for GATA type II thoracolumbar tuberculosis. [Methods] A retrospective study was conducted on 67 patients who received treat- ment for GATA type II thoracolumbar tuberculosis in our hospital from May 2017 to July 2019. Among them, 36 patients were treated with anti-tuberculosis chemotherapy alone (conservative group) , while the remaining 31 patients received anti-tuberculosis chemotherapy com- bined with pedicle screw fixation (operation group) . The documents regarding to early stage, follow-up, radiographs and laboratory tests were compared between the two groups. [Results] There was no significant difference in the incidence of early adverse reactions between the two groups (P＜0.05) . All the patients were followed up for (33.35±5.23) months, and the operation group resumed full weight-bearing activity significantly earlier than the conservative group (P＜0.05) . The VAS score, ODI score, JOA score, and ASIA neurological function grade in the two groups significantly improved over time (P＜0.05) . At the corresponding time points after treatment, the surgery group proved significantly superior to the conservative group in terms of ODI and JOA score (P＜0.05) , but there was no significant difference in ASIA grades between the two groups (P＞0.05) . The incidence of late complications in the surgery group was significantly lower than that in the conservative group (P＜0.05) . With regard to auxiliary examinations, the operation group proved significantly superior to conservative group in terms of the local kyphotic Cobb angle and lesion outcome observed on images after treatment (P＜0.05) , as well as C-reactive pro- tein (CRP) at 3 months after treatment and erythrocyte sedimentation rate (ESR) at 6 months after treatment (P＜0.05) . [Conclusion] Antituberculosis chemotherapy combined with pedicle screw fixation for GATA type II thoracolumbar tuberculosis does significantly relieve the early pain, accelerate rehabilitation, avoid the occurrence of kyphosis, and achieve clinical outcome considerably better than anti-tubercu- losis chemotherapy alone.