关键词: 结核,脊柱, 抗结核药, 治疗结果, 回顾性研究

Abstract:

Objective: To explore the efficacy and clinical application value of conservative treatment for mild spinal tuberculosis. Methods: A retrospective study was conducted 51 patients with spinal tuberculosis who were treated conservatively in the Orthopaedics Department of Hebei Chest Hospital from June 2015 to May 2018. The clinical data of them were collected. Those who without the results of Mycobacterium tuberculosis culture and drug sensitivity test were routinely given H-R-Z-E (H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol) anti-tuberculosis treatment, and the medication plan was adjusted according to the laboratory examination results (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)), imaging findings, and the improvement of clinical symptoms. Those who with Mycobacterium tuberculosis culture and drug sensitivity test results should be treated with 4-5 sensitive anti-tuberculosis drugs according to the drug sensitivity test results. For those who complicated with psoas major muscle and paravertebral abscess, local puncture or catheter drainage should be used as auxiliary treatment. For those who complicated with subcutaneous abscess, incision and drainage of subcutaneous abscess should be supplemented. For those who with local sinus formation, sinus curettage was performed. All patients were assisted by braces to maintain spinal braking. The changes of ESR and CRP, pain relief and cure rate of spinal tuberculosis were dynamically observed. Results: Mycobacterium tuberculosis culture and drug sensitivity test were carried out on 43 lesions or sputum samples of the subjects, of which 21 cases were positive (48.8%), 4 cases were drug-resistant. Eight subjects could not obtain specimens and were not cultured, but after application of routine anti-tuberculosis drugs, the clinical symptoms and inflammatory indicators gradually decreased to normal, and the bone lesions completely recovered. Four weeks after treatment, the ESR, CRP and VAS scores of the subjects were 28 (20, 37) mm/1 h, 25 (17, 34) mg/L and 3 (2, 4) respectively, which were significantly lower than those before treatment (36 (29,55) mm/1 h, 32 (26,40) mg/L and 5 (3,6), respectively)(Z values were -5.377, -5.260 and -6.017, respectively; all P values <0.001). All the subjects were well followed up for 18 to 30 months. And 48 cases of spinal tuberculosis were completely cured by conservative methods without recurrence, the cure rate was 94.1% (48/51). Conclusion: For mild spinal tuberculosis with indications, conservative treatment combined with necessary adjuvant treatment can achieve good results.

Key words: Tuberculosis, spinal, Antitubercular agents, Treatment outcome, Retrospective studies