經(jīng)皮穿刺置管介入治療脊柱結(jié)核并膿腫的臨床效果

吳于青+蔡隆仁+胡艷紅

[摘要]目的 探討經(jīng)皮穿刺置管介入治療脊柱結(jié)核并發(fā)膿腫的臨床應(yīng)用價(jià)值。方法 選擇2013年1～12月我院收治的60例脊柱結(jié)核合并膿腫患者，隨機(jī)分為對照組和觀察組，各30例。對照組行傳統(tǒng)開放病灶清除術(shù)治療，并化療18個(gè)月；觀察組在CT引導(dǎo)下行經(jīng)皮穿刺置管介入治療，保留引流管，采用異煙肼、利福平聯(lián)合阿米卡星局部治療4周，同時(shí)全身化療18個(gè)月（方案同對照組）。療程結(jié)束后隨訪觀察1～2年，比較兩組患者治愈率、復(fù)發(fā)率、并發(fā)癥發(fā)生率以及JOA評分變化情況。結(jié)果 觀察組治愈率與對照組比較，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；復(fù)發(fā)率極顯著低于對照組（P<0.01）；觀察組并發(fā)癥發(fā)生率顯著低于對照組（P<0.05）。治療后，兩組胸椎和腰椎JOA評分均顯著改善（P<0.05）；觀察組治療后胸椎JOA評分和腰椎JOA評分均分別極顯著高于對照組（P<0.05）。結(jié)論 CT引導(dǎo)下的精辟穿刺置管介入治療脊柱結(jié)核并膿腫具有效果較佳、術(shù)后復(fù)發(fā)和并發(fā)癥少、較好的臨床應(yīng)用價(jià)值。

[關(guān)鍵詞]脊柱結(jié)核；膿腫；經(jīng)皮穿刺置管；介入治療

[中圖分類號] R529.2 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1674-4721（2016）12（c）-0021-03

Clinical effect of percutaneous catheter intervention in the treatment of spinal tuberculosis complicated with abscess

WU Yu-qing1 CAI Long-ren2 HU Yan-hong1

1.Department of Tuberculosis，Jiangxi Chest Hospital，Nanchang 330006，China；2.Department of Tuberculosis，People′s Hospital of Ganzhou City in Jiangxi Province，Ganzhou 341000，China

[Abstract]Objective To study the clinical value of percutaneous catheter intervention in the treatment of spinal tuberculosis complicated with abscess.Methods 60 cases of spinal tuberculosis complicated with abscess in our hospital from January to December 2013 were randomly divided into control group and observation group，30 cases in each group.Patients in the control group were given conventional open debridement treatment，and chemotherapy for 18 months；patients in the observation group were given with CT guided percutaneous puncture tube interventional treatment，retention of drainage tube，using Isoniazid and Rifampin combined with Amikacin local treatment for 4 weeks，and systemic chemotherapy for 18 months （program with the control group）.After the course of treatment，patients were followed up for 1-2 years.Cure rate，recurrence rate，incidence rate of complications and change of JOA score between two groups were compared.Results There was significant difference in the cure rate between two groups （P<0.05），and recurrence rate was significantly lower than that of the control group （P<0.01）；incidence rate of complications in the observation group was significantly lower than that in the control group （P<0.05）.After treatment，thoracic and lumbar JOA score of two groups were significantly improved（P<0.05）；thoracic JOA score and lumbar JOA score of in the observation group after treatment were significantly higher than those in the control group （P<0.05）.Conclusion CT guided penetrating puncture catheter intervention in the treatment of spinal tuberculosis complicated with abscess has better results，fewer postoperative recurrence，fewer complications，and good clinical application value.