【摘要 】 目的 探讨脊椎结核治疗失败的原因及处理办法。方法 对1987 ～1996 年间收治的初次手术治疗失败的脊椎结核109 例进行回顾性分析。结果 治疗失败的主要原因为：化疗不合理及耐药菌株的产生；手术时机、术式选择及术中处理不当；多椎体病变、跳跃型病变及合并其他肺外结核。结论 治疗成功的关键是在合理用药的基础上严格掌握手术适应证、选择手术时机和手术途径，清除病灶，解除脊髓压迫，重建脊柱稳定性。

Zhang Weihong, Wu Qiqiu, LinYu, et al. Beijing Tuberculosis and Thoracic Tumour Institute, Beijing 101149

【Abstract 】 Objective To explore reasons failed focal debridement in treating spinaltuberculosis patients and methods to cope with them. Method One hundred nine patients with spinal tuberculosis who failedinitial focal debridement from 1987 to 1996 were reviewed. Result The reasons of operational failure were found to be theuse of unreasonable regimens and existance of drug resitant strains; inappropriateoperational indication, approach and treatment during operation; lesions involving severalvertebras, skipping destruction and complicating with other kinds of extrapulmonarytuberculosis. Conclusion Thekey to successful treatment of the disease is to choose appropriate operative indicationand approach, discard spinal cord pressure and rebuild spinal stability on the basis ofreasonable chemotherapy regimen.

     【Key words 】 Tuberculosis, osteoarticular Focal debridement Surgery,operative

方先之倡导的骨关节结核病灶清除疗法广泛采用已近40 年 ......