【摘要】 目的 分析胸腰椎结核病灶清除植骨融合内固定术后内固定失败的危险因素，为预防胸腰椎结核手术失败提供理论依据。方法 胸腰椎结核患者446例，均接受病灶清除植骨融合内固定术治疗并获得2年以上随访，随访期间发现内固定失败者48例。收集所有患者的基本资料、手术相关资料及术后随访资料，以是否发生胸腰椎结核病灶清除植骨融合内固定术后内固定失败为因变量，建立单因素Logistic回归分析模型，自变量包括性别、年龄、术前存在并发症、病灶范围、手术方式选择、术前及术后正规化疗、手术部位严格制动、合并脊柱外结核、术前合并后凸畸形、术前术后合并症、术后结核药物耐药，采用逐步筛选法进行单因素Logistic回归分析。将单因素分析有统计学意义的指标纳入多因素Logistic回归分析模型作为自变量，以胸腰椎结核病灶清除植骨融合内固定术后内固定失败为因变量，采用多因素Logistic回归分析法分析胸腰椎结核病灶清除植骨融合内固定术后内固定失败的危险因素。结果 单因素Logistic回归分析结果显示，病灶范围、手术方式选择、术前及术后正规化疗、手术部位严格制动、术前合并后凸畸形、术后结核药物耐药是胸腰椎结核病灶清除植骨融合内固定术后内固定失败的相关因素（P均<0.05）。多因素Logistic回归分析结果显示，病灶范围（多椎体）、手术方式（前路）、术前及术后未正规化疗、手术部位未严格制动、术前合并后凸畸形、术后结核药物耐药是胸腰椎结核病灶清除植骨融合内固定术后内固定失败的独立危险因素（P均<0.05）。结论 胸腰椎结核病灶清除植骨融合内固定术后有较高的内固定失败风险，病灶范围（多椎体）、手术方式（前路）、术前及术后未正规化疗、手术部位未严格制动、术前合并后凸畸形、术后结核药物耐药是胸腰椎结核病灶清除植骨融合内固定术后内固定失败的独立危险因素。更多还原

【Abstract】 Objective To analyze the risk factors of internal fixation failure after thoracolumbar tuberculosis lesion removal and bone graft fusion with internal fixation, and to provide theoretical basis for prevention of thoracolumbar tuberculosis surgical failure. Methods A total of 446 patients with thoracolumbar tuberculosis were treated with lesion removal and bone graft fusion with internal fixation surgery and were followed up for more than 2 years, during which 48 cases of failure of internal fixation were found. The basic data, surgical data and postoperative follow-up data of all patients were collected. A univariate Logistic regression analysis model was established with internal fixation failure after thoracolumbar tuberculosis lesion removal and bone graft fusion with internal fixation as the dependent variable. Independent variables included gender, age, preoperative complications, lesion scope, surgical mode selection, preoperative and postoperative formal chemotherapy, strict immobilization at surgical site, combined with extraspinal tuberculosis, combined with preoperative kyphosis, preoperative and postoperative complications, and postoperative tuberculosis drug resistance. Univariate Logistic regression analysis was performed by stepwise screening method. The indicators with statistically significant difference in univariate analysis were incorporated into the multivariate Logistic regression analysis model as independent variables, and the internal fixation failure after thoracolumbar tuberculosis lesion removal and bone graft fusion with internal fixation was taken as dependent variable. The risk factors for internal fixation failure after thoracolumbar tuberculosis lesion removal and bone graft fusion with internal fixation were analyzed by multivariate Logistic regression analysis. Results The results of univariate Logistic regression analysis showed that lesion scope, surgical mode selection, preoperative and postoperative formal chemotherapy, strict immobilization at surgical site, combined with preoperative kyphosis, and postoperative tuberculosis drug resistance were the relevant factors for the internal fixation failure after thoracolumbar tuberculosis lesion removal and bone graft fusion with internal fixation(all P<0. 05). The results of multivariate Logistic regression analysis showed that the lesion scope(multiple vertebrae), surgical method(anterior), irregular preoperative and postoperative chemotherapy, non-strict immobilization at surgical site, combined with preoperative kyphosis, and postoperative tuberculosis drug resistance were independent risk factors for internal fixation failure after thoracolumbar tuberculosis lesion removal and bone graft fusion with internal fixation(all P<0. 05). Conclusion Thoracolumbar tuberculosis lesion removal and bone graft fusion with internal fixation surgery has a high risk of internal fixation failure. The lesion scope(multiple vertebrae), surgical method(anterior), irregular preoperative and postoperative chemotherapy, non-strict immobilization at surgical site, combined with preoperative kyphosis, and postoperative tuberculosis drug resistance are independent risk factors for internal fixation failure after thoracolumbar tuberculosis lesion removal and bone graft fusion with internal fixation.更多还原