tibljТуберкулез и болезни легкихTuberculosis and Lung Diseases2075-12302542-1506Медицинские знания и технологии10.21292/2075-1230-2016-94-11-50-55tiblj-956Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESКОМОРБИДНОСТЬ И ПРОГНОЗИРОВАНИЕ РИСКА ВОЗНИКНОВЕНИЯ ПОСЛЕОПЕРАЦИОННЫХ ИНФЕКЦИОННЫХ ОСЛОЖНЕНИЙ У БОЛЬНЫХ ТУБЕРКУЛЕЗНЫМ СПОНДИЛИТОМCO-MORBIDITY AND FORECASTING THE RISK OF POST-OPERATIVE INFECTIOUS COMPLICATIONS IN TUBERCULOUS SPONDYLITIS PATIENTSБурлаковС. В.BurlakovS. V.

кандидат медицинских наук, старший научный сотрудник отделения фтизиовертебрологии,

191036, Санкт-Петербург, Лиговский пр., д. 2-4

Candidate of Medical Sciences, Senior Researcher of Phthisiovertebrology Department,

2-4, Ligovsky Ave., St. Petersburg, 191036

burlakovsv@mail.ruВишневскийА. А.VishnevskiyA. A.

доктор медицинских наук, руководитель отделения фтизиовертебрологии,

191036, Санкт-Петербург, Лиговский пр., д. 2-4

Doctor of Medical Sciences, Head of Phthisiovertebrology Department,

2-4, Ligovsky Ave., St. Petersburg, 191036

noemail@neicon.ruФГБУ «Санкт-Петербургский НИИ фтизиопульмонологии» Минздрава РоссииРоссияSt. Petersburg Research Institute of PhthisiopulmonologyRussian Federation20160111201694115055Copyright © Бурлаков С.В., Вишневский А.А., 20162016Бурлаков С.В., Вишневский А.А.Burlakov S.V., Vishnevskiy A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tibl-journal.com/jour/article/view/956Цель исследования

Цель исследования: изучение коморбидности и риска возникновения послеоперационных инфекционных осложнений у больных туберкулезным спондилитом (ТС) и неспецифическим остеомиелитом позвоночника (НОП) по шкалам ASA, PITSS и индексу коморбидности Чарлсона (ИКЧ).

Материалы и методы

Материалы и методы. Проведен ретроспективный анализ хирургического лечения 41 пациента с инфекционными спондилитами (ИС). Пациенты были разбиты на 2 группы. Больные ТС вошли в 1-ю группу - 24 (58,5%), 2-ю группу (17,0-41,5%) составили пациенты с НОП. Более половины больных ТС (13/54,3%) имели ВИЧ-инфекцию, у 16/24 (66,7%) пациентов имелся генерализованный туберкулез. Прогноз выживаемости больных после проведенного оперативного лечения рассчитан по ИКЧ, дана оценка степени риска операции и наркоза по шкале ASA, проведено прогнозирование риска послеоперационных осложнений по шкале PITSS (Postoperative infection treatment score for the spine) (2012).

Результаты

Результаты. Ранние и поздние инфекционные осложнения выявлены у 4 (9,7%) больных с риском по ASA 3-4 cт., ИКЧ более 5 баллов и PITSS высокой степени риска (более 21 балла). У больных ТС ИКЧ более 5 баллов и высокая степень риска по ASA (4 ст.) встречались чаще, чем среди больных НОП (p ≤ 0,05). Большинство пациентов с ИС (28/57,5%) имели средний и высокий риск развития ПОО по шкале PITSS. У ВИЧ-позитивных пациентов с ТС риск их возникновения был в 2 раза выше, чем у ВИЧ-негативных пациентов (χ2 = 4,53, OR = 2,76, p = 0,0012).

Goal of the study

Goal of the study: to study co-morbidity and risk of post-operative infectious complications in tuberculous spondylitis patients with concurrent non-specific spinal osteomyelitis as per ASA, PITSS scales and Charlson score.

Materials and methods

Materials and methods. Surgical treatment of 41 patients with infectious spondylitis was retrospectively analyzed. Patients were divided into 2 groups. Tuberculous spondylitis patients were included into group 1 – 24 (58.5%), and those suffering from non-specific spinal osteomyelitis were included into group 2 (17.0-41.5%) More than half of tuberculous spondylitis patients were HIV positive (13/54.3%) and 16 out of 24 patients (66.7%) had generalized form of tuberculosis. The survival forecast for the patients after surgery was estimated by Charlson score, ASA score was used for evaluation of surgical and anesthetic risks, and risk of postoperative complications was assessed by PITSS (Postoperative infection treatment score for the spine) (2012).

Results

Results. Early and late infectious complications were detected in 4 (9.7%) of patients with ASA at 3-4 scores, Charlson score exceeding 5 and high risk as per PITSS (more than 21 scores). Tuberculous spondylitis patients had Charlson score exceeding 5 and high risk as per ASA (4 scores) more often compared to those suffering from non-specific spinal osteomyelitis. The majority of infectious spondylitis patients (28/57.5%) had medium and high risk of postoperative complications development as per PITSS. HIV positive tuberculous spondylitis patients had two fold risk of postoperative complications development compared to those HIV negative (χ2 = 4.53, OR = 2.76, p = 0.0012). 

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The authors declare that there are no conflicts of interest present.