中国骨伤2026，Vol.39Issue(2)：148-153,6.DOI:10.12200/j.issn.1003-0034.20240948
脊柱结核病理骨折误诊误治因素分析及治疗措施
Misdiagnosis and mismanagement of pathological fractures in spinal tuberculosis:causes and management strategies
摘要
Abstract
Objective To explore the perioperative management of pathological fractures in spinal tuberculosis patients undergoing vertebral augmentation,and to provide clinical data for the differential diagnosis of spinal tuberculosis.Methods A retrospective analysis was conducted on the clinical data of 30 spinal tuberculosis patients who underwent vertebral augmenta-tion from April 2017 to May 2022.According to the treatment methods,the patients were divided into three groups:Group A(posterior spinal approach with bone cement mass removal,decompression,and bone graft fusion),Group B(posterior spinal decompression and bone graft fusion),and Group C(conservative treatment).Group A included 10 patients(6 males and 4 fe-males)with an average age of(68.50±6.81)years.Group B included 12 patients(8 males and 4 females)with an average age of(67.92±5.86)years.Group C included 8 patients(4 males and 4 females)with an average age of(65.00±7.09)years.All patients received anti-tuberculosis drug treatment for 18 to 24 months.The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),tuberculosis infection T-cell spot test(T-SPOT.TB),visual analogue scale(VAS)for pain,American Spinal Injury Association(ASIA)neurological function classification,and modified Barthel index(MBI)for assessing activities of dai-ly living were observed and compared among the three groups.Results All 30 patients were followed up at 3 and 12 months postoperatively.Among them,27 patients showed elevated ESR and CRP during the preoperative period,and tested positive for T-SPOT.TB;The remaining 3 patients had normal ESR and CRP levels and negative T-SPOT.TB results.In Group A,the VAS decreased from 7.05±1.09 before treatment to 1.85±0.81 at 12 months postoperatively,with a statistically significant difference(P＜0.05).In Group B,the preoperative VAS was 7.67±1.26,which decreased to 2.13±0.74 at 12 months postoperatively,showing a statistically significant difference(P＜0.05).In Group C,the VAS score decreased from 8.56±1.21 before treatment to 3.06±1.23 at 12 months after treatment,with a statistically significant difference(P＜0.05).The ESR and CRP levels of the three groups all returned to the normal range at 3 and 12 months postoperatively,which were significantly different from those before the operation(P＜0.05).At 12 months postoperatively,26 patients achieved complete recovery of ASIA neurological function,and 4 patients achieved partial recovery.The MBI scores of the three groups at 12 months after treatment were signifi-cantly improved compared with those before treatment(P＜0.05).Additionally,at 3 and 12 months after treatment,the MBI scores of Group A and Group B were superior to those of Group C,with statistically significant differences(P＜0.05).Conclu-sion Vertebral wedge deformation is not an exclusive indicator of primary osteoporotic fractures.Clinical details should be thor-oughly analyzed,and attention should be paid to the imaging changes of the soft tissues around the vertebral body and inflam-matory changes.Before vertebral augmentation,routine ESR,CRP tests,and enzyme-linked immunospot assays(T-SPOT.TB)are recommended.For spinal tuberculosis cases that have already undergone vertebral augmentation,individualized surgical treatment plans should be adopted.关键词
骨水泥/脊柱结核/椎体强化术/病理骨折Key words
Bone cement/Spinal tuberculosis/Vertebral augmentation/Pathological fractures分类
医药卫生引用本文复制引用
姚晖,李大伟,陈红玉..脊柱结核病理骨折误诊误治因素分析及治疗措施[J].中国骨伤,2026,39(2):148-153,6.基金项目
国家自然科学基金面上项目(编号:81972081) （编号:81972081）
中国中医科学院眼科医院高水平中医医院项目(编号:GSP5-31)National Natual Science Foundation of China(No.81972081) （编号:GSP5-31）
