Analysis Of The Effect Of Local Application Of Isoniazid Combined With Amikacin On Adult Spinal Tuberculosis

Background Bone and joint tuberculosis is the most common extrapulmonary tuberculosis,spinal tuberculosis which is most common,accounting for about 50%.The highest incidence is lumbar tuberculosis,followed by thoracic,cervical vertebra.Chemotherapy combined with surgical treatment is the main treatment of spinal tuberculosis.For the part of the spinal tuberculosis patients,which have to carry out surgical treatment,chemotherapy is the basic treatment of tuberculosis,and surgery can completely remove the focus,relieve nerve compression,reconst spinal stability and correct deformities.Both are indispensable.As anti tuberculosis therapy in traditional medicine,isoniazid plays an important role in the treatment of tuberculosis,even for drug-resistant forms,but also has a certain effect.Amikacin as a second-line antituberculosis drugs,which itself has a certain degree of control and kill Mycobacterium tuberculosis,can stop Mycobacterium tuberculosis from growing by interfering its protein synthesis and is not easy to produce drug resistance.The combination of the two,to a certain extent,can control Mycobacterium tuberculosis and kill lesions,thereby reducing the disease relapse.This study retrospectively analyzed local application of combination of isoniazid and amikacin in treatment of spinal tuberculosis in adult,observed the wound of the patients healing and sinus tract,postoperative recurrence,graft bone fusion rate and other indicators,and make evaluation.Objective The analysis and study the clinical curative effect of topical application of Isoniazid Combined with Amikacin on the treatment of adult spinal tuberculosis.Methods Take 47 patients of spinal tuberculosis,which accepted short course of chemotherapy and vertebral resection and bone graft fusion in the First Affiliated Hospital of Xinxiang Medical College from 2013 September to 2015 September,aged from 16 years to 60 years,as the sample of the study,and divide them into two groups: 24 cases were treated by posterior approach surgery(group A);other patients were treated by posterior approach surgery and local application of combination of isoniazid and amikacin(group B).All patients are required to have clear indications for surgery,preoperative received regular anti tuberculosis treatment for at least 2 weeks.Pathological results are confirmed spinal tuberculosis.Take patients' sinus formation,postoperative adverse reaction rate,bone graft fusion,postoperative recurrence rate,the ESR value of 4 weeks after surgery,the ESR value of 12 weeks after surgery as efficacy evaluation parameters.Make statistical analysis about these data and P<0.05 said that there was a difference and there was statistical significance.Results 1.Incidence of adverse reactions: A group of gastrointestinal adverse reactions(nausea,vomiting)in 6 cases(25%),B group of 3 cases(13.04%),the incidence of adverse reactions in the two groups was not statistically significant difference(P > 0.05);2.Sinus tract formation: a group with 1 cases(4.17%)sinus formation and group B without sinus formation.Compared the two groups,there is no statistical difference(P > 0.05);3.Bone graft fusion in 6 months after operation: there were 1 cases(4.17%)in group A and incomplete fusion in group B.There was no significant difference between the two groups(P > 0.05);4.Postoperative recurrence rate: A group of 1 cases(4.17%)recurrence,no recurrence of patients in the B group,there was no statistical difference between the two groups(P > 0.05);5.The ESR value of group A: before operation(34.98 + 4.93)mm/h,12 weeks after surgery(11.96 + 3.89)mm/h,B group ESR: before operation(35.27 + 4.81)mm/h,12 weeks after operation(10.79 + 4.05)mm/h,there was no significant difference between the two groups(P > 0.05);6.ESR value,which was tested at 4 weeks after operation,: A group(27.94±4.89)mm/h,B group(10.44±4.17)mm/h,there were statistically significant differences between the two groups(P<0.05).Conclusion For the patients with spinal tuberculosis,which have existence of the indications for surgery,surgery and topical application of Isoniazid Combined with Amikacin can reduce the postoperative ESR at 4th week,which has certain significance for the treatment of patients with spinal tuberculosis.