脊柱结核患者的特征：中国西南一教学医院七年经验。
Characteristics of patients with spinal tuberculosis: seven-year experience of a teaching hospital in Southwest China.
机构信息
Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Xinqiao Street, Chongqing, 400037, People's Republic of China.
出版信息
Int Orthop. 2012 Jul;36(7):1429-34. doi: 10.1007/s00264-012-1511-z. Epub 2012 Feb 23.
PURPOSE
The purpose of this study was to investigate the characteristics of patients managed for spinal tuberculosis at the orthopaedics department of a teaching hospital in Chongqing, China, between 2004 and 2010.
METHODS
The study used a retrospective chart review. The epidemiology, clinical features, laboratory test results, imaging study findings, and treatment methods were recorded.
RESULTS
The annual incidence of spinal tuberculosis was stable throughout the study period. There were 284 patients, 147 women and 137 men, with a mean age of 38.2 years. The majority of the lesions involved the thoracic spine (45.3%), followed by the lumbar spine (45.0%). Multiple level skip lesions were seen in 5.6% of cases. The erythrocyte sedimentation rate was normal in 26.8% of patients. The C-reactive protein (CRP) was normal in 30.2% of patients. Type A and type O were the most common blood types. Neurological involvement was seen in 21.8% of patients. Concomitant tuberculosis of the lung was seen in 73 (25.7%). The patients with middle school education and above account for 60.4% (102/169) in rural patients and 68.7% (79/115) in urban patients. Mean time from symptom onset to diagnosis was 18.0 months (range, three days to 360 months), and there was a significant difference between the rural patients (23.0 months) and the urban patients (10.7 months) (p=0.001, t=-3.300). Surgical treatment was performed in 233 patients (82.0%). The preferred surgical procedure was radical anterior debridement, bone grafting and internal fixation (132 patients, 46.5%). There were 13 patients (4.2%) with anti-tuberculous chemotherapy drug allergy or toxicity, streptomycin anaphylaxis and toxicity in 12, and isoniazide anaphylaxis and toxicity in one. No mortality was related to spinal TB.
CONCLUSION
The annual incidence of spinal tuberculosis remained unchanged throughout the study period and most of the patients did not pay much attention to the disease and received timely treatment. Thus, we should strengthen the census and treatment of spinal tuberculosis in Southwest China.
目的
本研究旨在调查 2004 年至 2010 年间中国重庆某教学医院骨科收治的脊柱结核患者的特征。
方法
本研究采用回顾性病历分析。记录流行病学、临床特征、实验室检查结果、影像学研究结果和治疗方法。
结果
研究期间，脊柱结核的年发病率保持稳定。共有 284 例患者，女性 147 例，男性 137 例，平均年龄 38.2 岁。病变主要累及胸椎（45.3%），其次是腰椎（45.0%）。5.6%的病例存在多个跳跃性病变。26.8%的患者红细胞沉降率正常。30.2%的患者 C 反应蛋白（CRP）正常。A型和 O 型血最为常见。21.8%的患者存在神经受累。73 例（25.7%）合并肺结核。中学及以上文化程度的患者在农村患者中占 60.4%（102/169），在城市患者中占 68.7%（79/115）。从症状出现到诊断的平均时间为 18.0 个月（范围为 3 天至 360 个月），农村患者（23.0 个月）与城市患者（10.7 个月）之间存在显著差异（p=0.001，t=-3.300）。233 例患者（82.0%）接受了手术治疗。首选的手术方式为根治性前路清创、植骨及内固定（132 例，46.5%）。有 13 例患者（4.2%）出现抗结核化疗药物过敏或毒性、链霉素过敏和毒性各 12 例、异烟肼过敏和毒性 1 例。无与脊柱结核相关的死亡病例。
结论
研究期间，脊柱结核的年发病率保持不变，大多数患者对该病重视程度不够，未能及时接受治疗。因此，我们应加强西南地区脊柱结核的普查和治疗。
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