骨病活动型脊柱结核合并截瘫的分期及临床意义

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目的回顾骨病活动型脊柱结核合并截瘫患者的病程分期、治疗方法及结果 ,探讨其临床意义。方法 33例骨病活动型脊柱结核合并截瘫患者,根据发病后出现截瘫的时间不同将病程分三个时期,急性期(6周内)8例,亚急性期(6周~3个月)10例,慢性期(>3个月)15例,分别给予抗结核药物治疗或抗结核药物加手术治疗,于入院(术前)及治疗后12个月,采用Frankel分级方法评定截瘫程度,术中观察压迫物的性质。结果急性期截瘫,术中观察压迫物主要为肉芽组织、脓液,治疗1年后随访,抗结核药物+手术治疗,Frankel A级1例,B级3例,均恢复到D级,C级3例恢复到E级;单纯抗结核药物治疗Frankel分级C级1例,恢复到D级。亚急性期截瘫,术中观察压迫物主要为脓液、干酪样物、肉芽组织、少量死骨,治疗1年后随访,抗结核药物+手术治疗,Frankel B级5例、C级4例均恢复到E级;单纯药物治疗,Frankel分级C级1例恢复到E级。慢性期截瘫,术中观察压迫物脓液、干酪样物、肉芽组织、坏死椎间盘及大量死骨,抗结核药物+手术治疗,1年后随访Frankel B级9例、C级4例均恢复到E级;单纯抗结核药物治疗,Frankel分级B级、C级各1例均恢复到E级。结论按病程对骨病活动型脊柱结核合并截瘫进行分期,对于临床治疗方案和判断预后有一定指导意义。亚急性期和慢性期截瘫患者的治疗效果和预后明显优于急性期截瘫患者。 Objective To review the clinical course, staging and treatment of patients with active osteoporosis and paraplegia of osteoporosis and to explore its clinical significance. Methods Thirty-three patients with active osteoporosis complicated with paraplegia were divided into three stages according to the time of onset of paraplegia. Eight cases were acute (6 weeks), subacute (6 weeks to 3 months) 10 Cases, chronic period (> 3 months) in 15 cases were given anti-TB drug or anti-TB drugs plus surgery in admission (preoperative) and 12 months after treatment, Frankel grading method to assess the degree of paraplegia, intraoperative Observe the nature of the oppression. Results Acute paraplegia, intraoperative observation of the pressure of granulation tissue, pus, 1 year follow-up after treatment, anti-TB drugs + surgery, Frankel A grade in 1 case, B grade in 3 cases, were restored to D, C 3 cases recovered to E level; anti-tuberculosis drug Frankel grading C-1 cases, restored to D-class. Subacute paraplegia, intraoperative oppression mainly pus, cheese-like material, granulation tissue, a small amount of sequestrum, follow-up after 1 year of treatment, anti-TB drugs + surgery, Frankel B grade 5 cases, C grade 4 cases Restored to E-class; simple drug treatment, Frankel grading C-1 cases recovered to E-class. Chronic paraplegia was observed intraoperative oppression of pus, cheese-like material, granulation tissue, necrosis of the disc and a large number of sequestrum, anti-TB drugs + surgery, 1 year follow-up Frankel B grade 9 cases, C grade 4 cases were restored to E grade; anti-TB drug therapy alone, Frankel grade B, C grade in 1 case were restored to E grade. Conclusion Staging of active osteoporosis with paraplegia according to the course of disease has some guiding significance for clinical treatment and prognosis. Subacute and chronic paraplegia patients with treatment effect and prognosis was significantly better than acute paraplegia patients.
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