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目的：探讨手术时机对活动型胸椎结核伴截瘫患者临床疗效的影响。方法：回顾性分析2009 年至2013 年我院收治的572 例脊柱结核患者的临床资料，根据纳入标准选择活动型胸椎结核伴截瘫患者29 例。依据截瘫症状发生至入院接受手术治疗时间进行分组，活动型结核伴截瘫分为发生截瘫后2 周内(第Ⅰ组)、2 周至4 周(第Ⅱ组)、4 周至7 周(第Ⅲ组)手术组，评价和比较其手术前后的VAS 评分、Cobb 角以及最终Frankel 分级的情况。结果：所有患者的切口均Ⅰ期愈合，平均骨性融合时间5.3 个月。术后及末次随访各组VAS 评分、Cobb 角明显改善。活动型结核伴截瘫2 周内、2 至4 周手术的患者神经功能恢复良好，24 例(96%)神经功能恢复至Frankel 分级D 级或E 级。截瘫发生后4 周至7 周(第Ⅲ组)手术亦有效。结论：以规范抗结核药物治疗为基础的胸椎结核伴截瘫，原则上应早期手术。病情复杂的活动型结核伴截瘫患者在合并症处理后手术的个体化治疗，亦可有效解除脊髓压迫，促进截瘫恢复，无须急诊手术。

英文摘要:

Objective:To analyze the clinical efficacy to select the surgical time of the active thoracic tuberculosis with paraplegia.Methods:A retrospective analysis of clinical data from 2009 to 2013 in our hospital treated 572 cases of spinal tuberculosis, select activities thoracic tuberculosis 29 patients with paraplegia according to the inclusion criteria. Based paraplegia symptoms admitted to surgery time are grouped into active TB with paraplegia occurred in 2 weeks (group Ⅰ ), 2 ~4 weeks (group Ⅱ), 4-7 weeks (group Ⅲ ) surgery group, evaluating VAS scores , the Cobb angle and the final classification of Fankel.Results:The incisions were all healing. 29 cases of patients with bone fusion average time 5.3 months. Postoperative follow-up VAS score, Cobb angle improved significantly, there are significant differences compared with the preoperative. The neurological recovery of active TB with paraplegia of group Ⅰand group Ⅱis well, 24 cases (96%) recovery of neurological function to Frankel grade D or E grade. Active TB with paraplegia occurred in 4-7 weeks surgery is also effective.Conclusion:The thoracic tuberculosis with paraplegia based on standardize anti-TB drugs,should be early operated in principle. Active TB disease with complicated situation can effectively relieve after complications be cured as early as possible, without emergency surgery.

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