Objective:To analyze the un-healing cause and management after operation of thoracolumbar tuberculosis.Methods:From January 2008 to December 2011,the data of 12 patients with postoperative un-healing thoracolumbar tuberculosis were retrospectively analyzed.There were 5 males and 7 females,with an average age of 51.3 years old (ranged,42 to 65).All the patients occurred different degree of vertebral destruction,abscess-formation,kyphosis and nerve functional injury at the first operation.Among them,11 patients underwent debridement and fusion with autogenous iliac bone grafting and internal fixation,1 patient underwent debridement and fusion with autogenous iliac bone grafting.At 2-6 months after operation,internal fixation loosening,fusion failure,abscess-ormation,or erythrocyte sedimentation rate increasing occurred in the patients.For the patients to adjust anti-tuberculosis scheme,2 patients were treated with puncture to multiple abscess combining with rifampicin local injection; 10 patients were reoperated with debridement and internal fixation adjusting.Results:At 1-2.5 years (mean 1.8 years) after follow-up,9 cases were cured finally.Re-admission had 3 cases because of re-occurred erythrocyte sedimentation rate increasing and abscess-formation at the 2-4 months after operation,whose bacterial culture showed more than 2 kinds of drug fast,and the treatment effect was still not ideal after adjusting anti-tuberculosis scheme.Conclusion:Insufficient anti-tuberculosis and bad nutritional status before operation,incomplete debridement and unreasonable fixation style during operation,inadequate drainage,irregular anti-tuberculosis and drug fast of Bacillus tuberculosis after operation are main reasons leading to un-healing of tuberculosis.Therefore,actively improving malnutrition,making individual operation plan before operation,ensuring complete debridement,rebuilding spinal stability,removing the compression of spinal cord,combining with postoperative effective,enough,regular combination chemotherapy are important guarantee to cure of spinal tuberculosis.%目的:分析胸腰段结核术后未愈的原因并探讨其防治对策.方法:对2008年1月至2011年12月收治的12例胸腰段脊柱结核术后未愈患者进行回顾性分析,男5例,女7例；年龄42～65岁,平均51.3岁；初次手术时均有不同程度的胸腰段骨质破坏、椎旁脓肿形成、后凸畸形及神经功能损害,其中11例行病灶清除植骨融合内固定术,1例行病灶清除加自体髂骨移植术.术后2～6个月分别发现内固定松动、融合失败、椎旁脓肿形成及血沉升高而再次入院.予以调整抗痨方案,其中2例予多次脓肿穿刺利福平针局部灌注治疗,10例行再次手术病灶清除及调整内固定治疗.结果:经1～2.5年(平均1.8年)随访.9例最终获得治愈.3例术后2～4个月又发现血沉升高,椎旁脓肿形成再次住院治疗,脓肿培养发现对2种以上药物耐药,调整抗痨方案后,治疗效果仍不理想.结论:术前抗痨不充分、营养状况不良,术中病灶清除不彻底、固定方式不合理,术后病灶引流不畅、抗痨不规则及结核杆菌耐药是造成胸腰段结核术后不愈的主要原因.术前应全面评估患者局部及全身状况,制定个体化的手术方案,确保术中彻底清除病灶、重建脊柱稳定、解除脊髓压迫,配合术后有效、足程、规则、联合化疗是保证脊柱结核治愈的重要对策.
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