老年人脊柱结核的围手术期处理

摘要

Objective To investigate the experience of perioperative of spinal tuberculosis in the aged. Methods A retrospective review of 44 aged patients with spinal tuberculosis who were surgically treated in our department from May 1998 to Oct 2008 was performed. The average age at the time of surgery was 71.4 years. The surgical procedures include: anterior debridement and bony grafting with anterior instrumentation fixation in 15 patients, anterior debridement and bony grafting with posterior fixation in 5 patients, posterolateral debridement and interbody fusion with posterior fixation in 10 patients, posterior debridement, posterior fixation in 11 patients and CT guided percutaneous catheter drainage in 3 patients. The patients were followed up for 1.5 -7. 0 years, with a mean period of 3. 7 years. The perioperative management and the results of the surgery were summarized and analyzed. Results Thirty - five patients suffered at least one type of concomitant diseases before operation. All patients survived surgery except one who died two weeks after operation. General complications maily included cardiac insufficiency, arrhythmia and respiratory infection. Local complications mainly included sinus, pedi-cal screws loosing, donor site of iliac bone pain. Tuberculous infection was controlled in 43 patients with no recurrence or reactivation occurred. Bony fusion was achieved in 39 patients. There were 2 pseudoarthrosis and no implant failure. The deformity was partial corrected at the final follow - up. Among 23 cases with neurologic deficit, 13 cases were completely recovered,6 were partly improved. Conclusion Surgical treatment for spinal tuberculosis appears to be a beneficial procedure for the aged patients. Meticulous preoperative preparation, active preventing and treating the intraoperative and postoperative complications ensure the perioperative safety.%目的 探讨老年人脊柱结核外科治疗的围手术期处理经验.方法 回顾分析行手术治疗的44例老年人脊柱结核的病例资料.年龄61～86岁,平均年龄71.4岁.合并截瘫者23例.15例行经前路病灶清除、植骨、前路内固定术；5例选择经前路清除病灶、植骨、后路内固定术；10例行采用经肋横突病灶清除、椎间植骨,后路椎弓根系统内固定术；11例行经后路病灶清除、植骨和内固定术；3例行CT引导下经皮穿刺置管引流术.随访时间1.5 ～7.0年,平均3.7年.总结住院期间合并症、并发症及其处置和手术疗效.结果 术前有内科合并症者35例.术后全身并发症22症次,主要包括心功能不全、心律失常及肺部感染等,1例术后肺部感染死亡,其余均安全度过围手术期.局部并发症23例次,主要包括窦道形成、髂骨供骨区疼痛及椎弓根螺钉松动等.术后1.5年、2.5年因心肌梗死及脑出血各死亡1例,余皆生存,病灶治愈.合并截瘫者完全恢复13例,部分恢复6例.结论 老年脊柱结核患者可选择手术治疗,积极的围手术期评估和正确处理围手术期合并症是老年人脊柱结核手术成功的重要保证.