CAJ | 학술논문

目的建立轻型脊柱结核诊断标准,评估标准化疗方案治疗轻型脊柱结核的疗效,为完善脊柱结核临床分型奠定基础.方法依照轻型脊柱结核诊断标准,纳入经影像学或病理学证实的轻型脊柱结核患者89例,经加强营养支持,无需卧床,采用严格标准化疗方案(异烟肼、利福平、乙胺丁醇、吡嗪酰胺)治疗18个月.化疗期间每个月监测肝功能、红细胞沉降率,于化疗后1、3、6、9、12、18、24个月门诊复查,分析治疗前后患者临床表现、疼痛视觉模拟评分(visual ana-loguescale,VAS)、病变愈合、Cobb角、神经功能、红细胞沉降率及肝功能的变化情况.结果所有患者均获得随访,随访时间18～46个月,平均(30.62±13.20)个月.85例(95.51％)获得临床治愈；4例经3个月化疗无效,红细胞沉降率增高,骨质破坏加重而行手术治疗,经药敏试验证实为耐药结核,调整化疗方案,术后化疗18个月后治愈.非手术临床治愈的85例患者,治疗前VAS评分平均为(5.6±1.6)分,后凸Cobb角平均为6.25°±3.11°；末次随访时VAS评分平均为(2.1±1.1)分,后凸Cobb角平均为12.36°±6.31°.获得临床治愈的85例中6例椎体、椎间盘恢复正常信号；79例获得邻近椎体自发融合,椎旁脓肿均吸收.69例残留无症状的轻度后凸畸形,均正常日常活动,无神经功能障碍.治疗前2例窦道形成者均愈合.结论早期诊断的轻型脊柱结核可作为脊柱结核临床分型中最轻的一型,标准化疗安全有效,非手术治疗能避免后凸畸形、脊柱失稳、神经功能障碍等并发症.
목적 건립경형척주결핵진단표준,평고표준화료방안치료경형척주결핵적료효,위완선척주결핵림상분형전정기출.방법 의조경형척주결핵진단표준,납입경영상학혹병이학증실적경형척주결핵환자89례,경가강영양지지,무수와상,채용엄격표준화료방안(이연정、리복평、을알정순、필진선알)치료18개월.화료기간매개월감측간공능、홍세포침강솔,우화료후1、3、6、9、12、18、24개월문진복사,분석치료전후환자림상표현、동통시각모의평분(visual ana-loguescale,VAS)、병변유합、Cobb각、신경공능、홍세포침강솔급간공능적변화정황.결과 소유환자균획득수방,수방시간18～46개월,평균(30.62±13.20)개월.85례(95.51％)획득림상치유；4례경3개월화료무효,홍세포침강솔증고,골질파배가중이행수술치료,경약민시험증실위내약결핵,조정화료방안,술후화료18개월후치유.비수술림상치유적85례환자,치료전VAS평분평균위(5.6±1.6)분,후철Cobb각평균위6.25°±3.11°；말차수방시VAS평분평균위(2.1±1.1)분,후철Cobb각평균위12.36°±6.31°.획득림상치유적85례중6례추체、추간반회복정상신호；79례획득린근추체자발융합,추방농종균흡수.69례잔류무증상적경도후철기형,균정상일상활동,무신경공능장애.치료전2례두도형성자균유합.결론 조기진단적경형척주결핵가작위척주결핵림상분형중최경적일형,표준화료안전유효,비수술치료능피면후철기형、척주실은、신경공능장애등병발증.
Objective To set the criteria of mild spinal tuberculosis and investigate the ettect of standard chemotherapy regimen for further establishing the clinical classification of spinal tuberculosis and standardizing management.Methods According to the criterion,a total of 89 patients with mild spinal tuberculosis were enrolled for outpatient conservative management and follow-up.Ambulant treatments were carried out in all patients,including nutrition support and standard chemotherapy regimen.The regimen was consisting of four first-line antituberculosis drugs (rifampicin,isoniazid,ethambutol and pyrazinamide).All patients were followed up one month later,then every 3 months for the following 12 months,and subsequently at intervals of half a year.The clinical manifestations,kyphosis progression,neurological status,erythrocyte sedimentation rate and liver function were analyzed.Results A mean of 30.62± 13.20 (range,18-46) months' follow-up was achieved in 85 patients,whose tuberculosis lesions were cured completely.Another 4 patients,who were diagnosed with drug-resistant tuberculosis later,had underwent surgery for progressive bone destruction and no response to chemotherapy.The mean visual analogue scale score and Cobb's angle was 5.6± 1.6 and 6.25°±3.11° before chemotherapy,and 2.1 ± 1.1 and 12.36° ±6.31 °at the last follow-up time,respectively.Signals of vertebral body and intervertebral disc returned to normal in 6 patients,while solid bony fusion of adjacent segment was achieved in 79 patients.Asymptomatic mild kyphosis was observed in 69 patients.2 patients with sinus before treatment all healed.No neurological deficit was found.Conculusion For patients early diagnosed with mild spinal tuberuclosis,standard chemotherapy regimen could work safely and effectively for healing the tuberculous lesion,avoiding surgery as well as preventing kyphosis,vertebral instability and neurological deficit.Mild spinal tuberculosis that was early diagnosed could be considered as a subtype of spinal tuberculosis.