| BackgroundAbout one-third(about 2 billion)people worldwide have been infected with M.tuberculosis.China is a high-burden country for tuberculosis infection,and the southwest region is a high-risk area for domestic tuberculosis.About 4% of all tuberculosis cases have muscle and bone infections,and spinal tuberculosis accounts for about 50% of bone and joint tuberculosis.Since the discovery of anti-tuberculosis drugs,the cure rate and prognosis of patients with spinal tuberculosis have been greatly improved,but patients with neurological damage and spinal deformity have always had a very significant impact on patients' quality of lif e.When patients with severe neurological impairment,spinal deformity or poor conservative treatment,surgical treatment,surgical treatment combined with postoperative chemotherapy should be considered,shortening the treatment time,improving the progno sis and quality of life of patients.Studies have shown that the clinical and imaging efficacy of tuberculosis removal and bone graft + anti-tuberculosis treatment for 6-9 months is comparable to the conservative treatment for 18 months.Current surgical methods include simple anterior surgery,anterior and posterior combined surgery,and simple posterior surgery.Most of the patients with spinal tuberculosis who have undergone surgery can recover,but some patients have localized pain,neurological dysfunction,and masses and sinus in the incision.The bone destruction is seen on the imaging surface,and the abscess is formed.Tuberculosis recurrence?Patients with recurrence have many differences in clinical performance,imaging and laboratory results compared with the initial patients,which makes the early diagnosis of recurrent tuberculosis more difficult.Due to bone destruction,deformity,drug resistance,previous surgery,etc.,relapsed tuberculosis is difficult to treat again.At present,there are f ew studies on the characteristics and treatment of postoperative recurrence of thoracic and lumbar spinal tuberculosis.Therefore,this study intends to retrospectively analyze the recurrence of thoracolumbar tuberculosis,summarize its case characteristics and clinical significance,and provide a certain basis for the early diagnosis of recurrent thoracolumbar tuberculosis.And combined with our experience in the treatment of patients with recurrent chest and lumbar tuberculosis,provide effective guidance for patients to improve prognosis.PurposeRetrospective analysis of case data and clinical treatment results of patients with postoperative recurrence of thoracolumbar tuberculosis,summarizing their common clinical case characteristics,providing evidence-based medical evidence for early diagnosis,early treatment and improvement of patient prognosis.Combined with our experience in the treatment of patients with recurrence of thoracic and lumbar spinal tuberculosis,we provide a treatment strategy for the treatment of patients with recurrent thoracolumbar tuberculosis..Material and Methods1?Retrospective analysis of patients with thoracolumbar tuberculosis who were hospitalized in our hospital from January 2006 to January 2016.69 cases of postoperative recurrence of thoracolumbar tuberculosis were selected,36 of which were operated in our hospital for the first time and 33 in the first hospital.The age at the first operation was 5 to 67 years old,with an average of(36.1 ± 14.2)years;the age at recurrence was 7 to 69 years,with an average of(37.5 ± 14.5)years old.Of the 69 patients with recurrence,36 had lumbar spinal tuberculosis,13 had thoracic tuberculosis,and 20 had thoracic and lumbar tuberculosis.There were 41 patients with single segment,20 patients with 2 segments,and 8 patients with multiple segments(6 in 3 segments,2 in 3 or more segments,and 1 patient in 1 patient)Segments,from the chest 6 vertebrae to the lumbar 5 vertebrae).In addition,statistics from January 2011 to June 2016,273 cases of thoracic and lumbar tuberculosis patients after the first operation,C,1 and 3,6 months after C protein and ESR values.A retrospective analysis of 60 cases of thoracolumbar tuberculosis recurrence after hospitalization and treatment from January 2006 to January 2016 was performed.According to the treatment,they were divided into two groups: group A was CT drainage group,9 cases,5 males,4 females,age(35.5±8.5)years old,under CT guided puncture drainage + local chemotherapy;group B was surgery Group,51 cases,30 males,21 females,age(38.5±12.5)years old,20 cases of anterior approach for initial operation,10 cases of posterior approach,30 cases of anterior and posterior approaches,and anterior or posterior tuberculosis lesions were removed.Bone graft fusion internal fixation.22 patients had kyphosis,and the average kyphosis angle was 35.8°±12.6°.19 patients had neurological dysfunction(ASIA classification: 1 case of grade B,5 cases of grade C,13 cases of grade D).Analysis of clinical general data,first symptoms,imaging,laboratory changes,drug-resistant tuberculosis,recurrence time,etc.And analyze the treatment of recurrent thoracic and lumbar tuberculosis patients with tuberculosis,clinical information,imaging changes and complications,etc.Results1?Among the patients with recurrence of thoracolumbar tuberculosis,the most common first clinical manifestation was sinus formation(26 cases,37.7%),followed by intraoperative pain(18 cases,26.1%),and local abscess mass formation again(17 cases,24.6%).The most common imaging findings were: 89.9% with paraspinal abscess(62 cases),37.7% with flow abscess(26 cases),and 36.2% with kyphosis(25 cases).53 cases of tuberculosis bacteria culture positive,and further drug sensitivity test,22 cases of drug-resistant tuberculosis,the proportion of drug-resistant tuberculosis was 41.5%.44.9%(31 cases)combined with other systemic tuberculosis,the most common of which were tuberculosis(40.5%)(28 cases).The time of recurrence: 32 cases within 6 months,9 cases from 6 to 12 months,8 cases from 12 to 18 months,4 cases from 18 to 24 months,3 cases from 24 to 36 months,and 5 cases from 36 to 48 months 3 cases were 48 to 60 months,5 cases were over 60 months,and the longest time was 84 months(7 years).Forty-three patients relapsed once,and 26 patients had multiple recurrences.Of the relapsed patients,37.7% had recurrence of tuberculosis.2?All patients were followed up for 40.5 ± 13.3 months.The average catheterization time of 9 patients in group A was 83.5±13.5 days without complications.There were no recurrence,abscess formation and sinus formation in 6 patients with tuberculosis.The patients recovered after 24 months of follow-up;1 patient had poor drainage,and was converted to surgery(anterior).The patients were cured after 36 months of follow-up;2 patients The initial drainage results were good,but pain,abscess and sinus formation occurred again after 1 year.Surgical treatment(1 case for posterior approach,1 case for anterior and posterior approach),follow-up for more than 24 months,and patients recovered at the last follow-up.Group B received 12 cases of anterior approach,25 cases of anterior and posterior approaches,and 14 cases of posterior surgery.The operation time was 115-485 min,with an average of 225±55 min.The amount of bleeding is 200-2500 ml,with an average of 850±140ml.In 22 patients with kyphosis,the angle of kyphosis was(8.3 ± 3.5)o,the angle was(9.5 ± 2.6)° at the last follow-up,and the angle after malformation was lost(2.2 ± 1.1)o.In patients with neurological dysfunction,1 patient with grade B recovered to grade D;5 patients with grade C,1 recovered to grade D,4 recovered to grade E;13 patients with grade D,1 patient still had grade D after treatment The remaining 12 patients recovered to grade E.Complications: 3 cases of pleural rupture,2 cases of cerebrospinal fluid leakage,1 case of pulmonary infection,and 1 case of wound infection.Forty-three patients(84.3%)underwent surgery for more than 24 months.Imaging showed no lesions,adjacent vertebral segments had reached grade A or B of bone fusion,and the lesions healed;2 patients(3.9%)At the postoperative follow-up,the patient developed abscess and bone destruction again.After CT-guided puncture + local anti-tuberculosis drug infusion chemotherapy,the patients were followed up for more than 24 months.The patients were cured at the last follow-up;6 patients(11.8%)were again Recurrence,surgical treatment after evaluation,follow-up for more than 24 months,the patient recovered at the last follow-up.ConclusionThoracic and lumbar tuberculosis patients undergoing surgical treatment,24 months after surgery is a dangerous period of postoperative recurrence,relapsed patients are prone to recurrence.Postoperative sinus drainage,surgical pain and local mass formation can be used as early warning indicators for postoperative recurrence.CRP and ESR are the most simple and sensitive indicators for recurrence in our follow-up.And above CRP,ESR exceeds the normal level,alert patients to the possibility of postoperative recurrence,early warning indicators or CRP,ESR higher than normal values,as early as possible MRI clear diagnosis,early treatment,which is important to improve the prognosis of patients with postoperative recurrence Clinical significance.CT-guided puncture + local anti-tuberculosis drug infusion chemotherapy and surgery are effective methods for the treatment of patients with recurrent thoracolumbar tuberculosis,and the two treatment methods are not opposite.The appropriate treatment should be selected according to the actual situation of the patient.In patients with relapse,the proportion of drug resistance is high,and patients should be treated according to the individualized anti-tuberculosis program under the guidance of drug susceptibility results.Combine drug susceptibility results with the patient's own situation to develop a treatment strategy,choose the right treatment strategy,and obtain good clinical efficacy. |
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