Clinical Study Of Short-course Chemotherapy Before Thoracolumbar Spinal Tuberculosis Postconditioning

Objective:To study the clinical efficacy and influence of short-term intensive chemotherapy before thoracolumbar spinal tuberculosis.Methods:Retrospectively analyzed the clinical data of 123 patients with thoracolumbar spinal tuberculosis treated from August 2016 to August 2018,and were divided into short-term intensive chemotherapy group(1-7 days)and traditional quadruple chemotherapy according to the time of preoperative chemotherapy Group(2 to 4 weeks)Among them,53 patients in the short-term intensive chemotherapy group,23 males and 30 females,aged 14 to 75 years old,with an average of 45.3 years old,were treated with isoniazid(INR)and rifampicin(RFP)(INR 300 mg),RFP 600 mg intravenous infusion/day),Ethambutol(EMB),Pyrazinamide(PZA)(EMB 750mg,PZA750mg,morning service/day),strengthen anti-tuberculosis;traditional quadruple There were 70 patients in the chemotherapy group,including 32 males and 38 females,aged 12-77 years old,with an average of 46.4 years old.Preoperative traditional quadruple chemotherapy By collecting clinical data,erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP),postoperative incision delayed healing rate,tuberculosis recurrence rate,and clinical symptom remission,compare the above two Differences in ESR,CRP,postoperative complication rate and clinical efficacy among the patients in the group.Results:All the collected 123 patients with thoracolumbar spinal tuberculosis successfully completed stage I tuberculosis debridement+bone graft fusion internal fixation,including 53 cases in the short-term intensive chemotherapy group,the operation time was 195-478 min,and the average was 313 min.～1800 mL,average 338 mL;70 patients in traditional quadruple chemotherapy group,operation time 197～498 min,average 327 min;bleeding volume 65～1500 mL,average 312 mL,no difference in operation time and intraoperative blood loss between the two groups Statistical significance(P>0.05).There were no cases of death or spinal cord injury in the above two groups of patients.There was no delayed healing of the incision after operation,and there was no dissemination of Mycobacterium tuberculosis.After short-term intensive chemotherapy and traditional quadruple chemotherapy before operation,serum ESR and CRP levels showed diversity,ESR It decreased to normal level within 1 to 3 months after surgery,and CRP reached normal level within 1 to 2.5 months after surgery.There was no statistically significant difference in ESR and CRP between the two groups of patients before and after surgery(P>0.05);The VAS scores of the two groups of patients decreased significantly with time.The above two groups of patients achieved good clinical efficacy.Among them,the short-term intensive chemotherapy group had a significant improvement in neurological function compared with before surgery,and there was no increase in paraplegia;except for relapses In addition to the patients,the above two groups of patients achieved osseous fusion,bone graft fusion time,the average of 4.5 months in the short-term intensive chemotherapy group,and the average of 4.7 months in the traditional quadruple chemotherapy group,the difference was not statistically significant(P>0.05);There were 5 patients with recurrence of lumbar spinal tuberculosis after surgery,including 2 patients in the short-term intensive chemotherapy group before surgery and 3 patients in the traditional four-way chemotherapy group before surgery.The difference was not statistically significant(P>0.05).Conclusion:Patients with thoracolumbar spinal tuberculosis obtained satisfactory results after short-term preoperative intensive treatment and traditional quadruple chemotherapy,and patients with thoracolumbar spinal tuberculosis who had progressive neurological deterioration should be strengthened before surgery After anti-tuberculosis treatment,the general condition is good,the chemotherapy time is less than 2 weeks,and can be actively treated by surgery treatment.