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目的 :探讨耐多药脊柱结核的临床特点和治疗方法。方法 :回顾分析总结该院 1997年 3月～ 2 0 0 0年 3月收治的 8例难治性脊柱结核的临床表现、病理、病程和治疗特点 ,以及药物敏感试验结果 ,对耐多药结核菌采用新的药物组合抗痨 ,如利福喷丁 +吡嗪酰胺 +氟嗪酸 (氧氟沙星 ) +丁胺卡那霉素 (阿米卡星 )或利福喷丁+吡嗪酰胺 +氟嗪酸 +阿莫西林 -棒酸 ,疗程 18～ 2 4个月。有手术指征者行手术治疗。结果 :3例初发病例 ,2例行手术治疗者伤口分别于术后 1月和 1.5月愈合并拔除引流管 ,1例多部位结核患者未行手术治疗起病后 6周死亡。 4例复发病例窦道闭合时间最短为术后 1个月、最长 3个月 ,1例窦道长期不愈合。术后随访2～ 3年 ,6例无复发 ,1例窦道仍持续流脓。结论 :耐多药脊柱结核具有临床症状重 ,治疗困难、疗程长的特点 ,对有明确手术指征的患者术后负压引流和联合应用足够疗程的多种非一线抗结核药物才有可能使病变治愈。
Objective: To investigate the clinical features and treatment of multidrug-resistant spinal tuberculosis. Methods: The clinical manifestations, pathology, course of disease and treatment characteristics of 8 refractory spinal tuberculosis admitted to our hospital from March 1997 to March 2000 were retrospectively analyzed. The results of drug sensitivity test were analyzed. The bacteria use a new combination of anti-tuberculosis drugs, such as rifapentine + pyrazinamide + triflumuron (ofloxacin) + amikacin (amikacin) or rifapentine + pyrazinamide + Ofloxacin + amoxicillin - clavulanic acid, treatment of 18 to 24 months. Surgical treatment of surgical indications. Results: The wounds were healed and drained at 1 month and 1.5 months postoperatively in 3 cases and 2 cases respectively. One case of multi-site tuberculosis patients died without operation after 6 weeks. In 4 cases, the shortest sinus closure time was 1 month after surgery, up to 3 months, and 1 case of long-term nonunion of sinus. Follow-up 2 to 3 years after surgery, 6 patients without recurrence, 1 case of sinus continued pus. Conclusion: MDR-TB is characterized by severe clinical symptoms, difficult treatment and long course of treatment. It is possible to use a variety of non-first-line anti-TB drugs after negative pressure drainage and combined application of sufficient course of treatment in patients with definite operation indications Lesion cured.