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目前在我国骨关节结核疫情较为严重,仍是常见的多发病,本病早期诊断、早期化疗可以治愈,而化疗在治疗中的重要性多未引起骨科工作者应有的重视。国内外大多集中于肺结核短程化疗的研究,骨关节结核短程化疗研究甚少。我院骨科1993年完成了15例初治脊柱结核短程化疗的研究,现就研究情况报告如下: 1 临床资料 1.1 选例标准:(1)年龄15～65岁,病变位于颈椎_2～骶椎_2的脊椎结核(跳跃型除外)。(2)肝、肾功能正常,不合并糖尿病,非孕妇、无活动骨外结核和其它部位的骨结核,无严重的心血管疾病,精神病癫痫病史者。(3)治疗开始时不合并截瘫或瘘管者。(4)接受其它化疗药物连续不超过四周者。 1.2 一般资料:男性4例,女性11例。年龄15～45岁,平均28岁。农民13例,工人1例,学生1例。病变部位:胸椎7例,胸腰段2例,腰椎6例。病程最短2个月,最长10年,平均23.6个月。治疗前:15例均有午后低热。血沉>20mm/h者13例,肝肾功能均正常。均有不同程度腰背痛,伴有下肢痛5例,腰三角突出脓肿6例,脊柱明显畸形10例。X线:15例均有骨质破坏,死骨阴影11例,脓肿阴影15例。入院后卧木板床休息、化疗,15例均行手术清除病灶,其中1例行自+异体骨移植固定术。 1.3 短化方案:3SHRZ/4R_3H_3+手术。Sm上海四药,RFP延安,INH和PZA信谊。
At present, the epidemic situation of bone and joint tuberculosis in our country is more serious, and it is still a common frequently-occurring disease. Early diagnosis of this disease and early chemotherapy can be cured. However, the importance of chemotherapy in treatment has not caused the orthopedic workers much attention. At home and abroad mostly concentrated on the study of short-course chemotherapy for tuberculosis, few studies on the short-range chemotherapy of tuberculosis of the joint. Orthopedics in our hospital completed in 1993 15 cases of initial treatment of spinal tuberculosis short-course chemotherapy, the research is reported as follows: 1 Clinical data 1.1 Selection criteria: (1) aged 15 to 65 years old, lesions located in cervical _2 ~ sacral vertebral _2 of spinal tuberculosis (jumping type excluded). (2) liver and kidney function is normal, without diabetes, non-pregnant women, non-active bone tuberculosis and other parts of the bone tuberculosis, no serious cardiovascular disease, history of mental illness epilepsy. (3) the beginning of treatment does not merge paraplegia or fistula. (4) to accept other chemotherapy drugs for less than four weeks in a row. 1.2 General Information: 4 males and 11 females. Aged 15 to 45 years old, with an average of 28 years old. 13 farmers, 1 worker and 1 student. Lesions: thoracic 7 cases, thoracolumbar 2 cases, lumbar 6 cases. The shortest course of 2 months, up to 10 years, an average of 23.6 months. Before treatment: 15 cases had afternoon fever. ESR> 20mm / h in 13 cases, liver and kidney function are normal. There are varying degrees of low back pain, accompanied by lower extremity pain in 5 cases, 6 cases of abscess prominent in the lumbar triangle, 10 cases of significant deformity of the spine. X-ray: 15 cases had bone destruction, dead bone shadow in 11 cases, 15 cases of abscess shadow. After admission, the wooden bed was rest and chemotherapy was performed. Fifteen patients underwent surgery to clear the lesion. One patient underwent autograft and allogeneic bone grafting. 1.3 short program: 3SHRZ / 4R_3H_3 + surgery. Sm Shanghai IV, RFP Yan’an, INH and PZA Xinyi.