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背景:目前由于耐药结核杆菌的出现、结核患者的管理不当等原因,脊柱结核术后结核迁延不愈或者复发的患者逐渐增加,尤其是易感性较强的小儿患者。因此对于小儿脊柱结核术后迁延不愈或复发的高危因素研究,对于结核的防治有重要的意义。目的:总结分析小儿脊柱结核术后结核迁延不愈或复发的相关危险因素,评价其个体化再次修复治疗的效果。方法:回顾性分析1998年6月至2013年6月行手术治疗145例脊柱结核患儿的临床资料,对其中术后脊柱结核迁延不愈或者复发患儿的临床资料与同期其他患儿进行对比,应用Logistic回归分析比较两组患儿的年龄、性别、自身营养情况、病灶清除是否彻底、修复前后正规化疗、是否置入内固定、伴发脊柱外结核、病灶范围、术前血沉>60 mm/h、术后出现并发症与脊柱结核术后迁延不愈或复发的相关性,分析可能导致脊柱结核术后迁延不愈或复发的危险因素;对于再次修复治疗的患儿,定期复查血沉、C-反应蛋白以及影像学指标,评价修复效果。结果与结论:29例患儿术后出现了结核的迁延不愈或复发,其中12例患儿再次行修复治疗,小儿脊柱结核术后迁延不愈或复发的发生率为20%,再手术率为8.3%。Logistic回归分析提示自身营养情况、修复前后正规化疗、病灶清除是否彻底、病灶范围与术后脊柱结核的迁延不愈或复发存在显著相关性(P<0.05);年龄、性别、是否置入内固定、伴发脊柱外结核、修复前血沉>60 mm/h、修复后出现并发症与小儿脊柱结核术后迁延不愈或复发无相关性(P>0.05);个体化的再次修复治疗可获得良好的效果。提示小儿脊柱结核术后迁延不愈或复发的原因复杂,加强自身营养、彻底清除病灶、严格正规化疗可以有效减少小儿脊柱结核术后迁延不愈或复发。根据初次修复方式结合患儿的具体病情制定个体化的再次修复方案是治疗脊柱结核术后迁延不愈或复发成功的关键。
BACKGROUND: At present, due to the emergence of drug-resistant Mycobacterium tuberculosis and the mismanagement of tuberculosis patients, the patients with recurrent tuberculosis after spinal tuberculosis gradually increase, especially in pediatric patients with high susceptibility. Therefore, pediatric patients with persistent postoperative spinal tuberculosis or recurrence risk factors for the prevention and treatment of tuberculosis is of great significance. OBJECTIVE: To summarize and analyze the related risk factors of delayed healing or recurrence of tuberculosis after pediatric spinal tuberculosis surgery, and to evaluate the effect of its individualized re-treatment. Methods: The clinical data of 145 cases of spinal tuberculosis treated surgically from June 1998 to June 2013 were retrospectively analyzed. The clinical data of postoperative patients with recurrent spinal tuberculosis or recurrence were compared with those of other children in the same period Logistic regression analysis was used to compare the age, sex, self-nutritional status of the two groups, whether the lesions were completely cleared, the regular chemotherapy before and after the repair, the internal fixation, the extra-spine tuberculosis, the extent of the lesion, the preoperative ESR> 60 mm / h, postoperative complications and postoperative delayed union or recurrence of spinal tuberculosis, the analysis may lead to delayed postoperative spinal tuberculosis or recurrence of risk factors; for children with re-repair treatment, regular review of erythrocyte sedimentation rate, C-reactive protein and imaging indicators, evaluate the repair effect. RESULTS AND CONCLUSION: Twenty-nine cases of postoperative delayed tuberculosis recurrence or recurrence, of which 12 cases of children underwent re-treatment, pediatric spinal tuberculosis postoperative delayed recurrence or recurrence rate was 20%, reoperation rate 8.3%. Logistic regression analysis showed that there was a significant correlation between self-nutritional status, formal chemotherapy before and after repair, complete lesion clearance, extent of lesion and postoperative recurrence or recurrence of spinal tuberculosis (P <0.05); age, gender, , Accompanied by extra-spine tuberculosis, repair of ESR> 60 mm / h, postoperative complications and recurrence of pediatric spinal tuberculosis postoperative recurrence or relapse was not related (P> 0.05); individualized re-repair treatment was good Effect. Prompt pediatric spinal tuberculosis postoperative delayed healing or recurrence of complex reasons to strengthen their nutrition, complete removal of lesions, strict formal chemotherapy can effectively reduce the pediatric spinal tuberculosis postoperative delayed healing or recurrence. According to the initial repair combined with the specific conditions of children develop individualized re-repair program is the treatment of spinal tuberculosis postoperative delayed recurrence or recurrence key.