吴于青+蔡隆仁+胡艳红

[摘要]目的 探討经皮穿刺置管介入治疗脊柱结核并发脓肿的临床应用价值。方法 选择2013年1～12月我院收治的60例脊柱结核合并脓肿患者，随机分为对照组和观察组，各30例。对照组行传统开放病灶清除术治疗，并化疗18个月；观察组在CT引导下行经皮穿刺置管介入治疗，保留引流管，采用异烟肼、利福平联合阿米卡星局部治疗4周，同时全身化疗18个月（方案同对照组）。疗程结束后随访观察1～2年，比较两组患者治愈率、复发率、并发症发生率以及JOA评分变化情况。结果 观察组治愈率与对照组比较，差异有统计学意义（P<0.05）；复发率极显著低于对照组（P<0.01）；观察组并发症发生率显著低于对照组（P<0.05）。治疗后，两组胸椎和腰椎JOA评分均显著改善（P<0.05）；观察组治疗后胸椎JOA评分和腰椎JOA评分均分别极显著高于对照组（P<0.05）。结论 CT引导下的精辟穿刺置管介入治疗脊柱结核并脓肿具有效果较佳、术后复发和并发症少、较好的临床应用价值。

[关键词]脊柱结核；脓肿；经皮穿刺置管；介入治疗

[中图分类号] R529.2 [文献标识码] A [文章编号] 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.