Moon Myung-Sang, Moon Young-Wan, Moon Jeong-Lim, Kim Sung-Sim, Sun Doo-Hoon
Department of Orthopedic Surgery, Sun General Hospital, Taejon, Korea.
Clin Orthop Relat Res. 2002 May(398):40-9. doi: 10.1097/00003086-200205000-00007.
Fifty-six adults (average age, 38 years) with active tuberculosis of the lumbar and lumbosacral spine were treated conservatively with triple chemotherapy for 12 to 18 months. The minimum followup was 3 years. Three methods of assessments of the chronologic changes of sagittal spinal deformity were used on lateral radiographs of the lumbar spine obtained with the patient standing: deformity, kyphos angles, and total lumbar lordosis. The lumbosacral joint angle was measured for tuberculosis of the lumbosacral joint. The disease healed in all patients with a minimum increase of kyphosis, although in 23 patients there was minimal new involvement of the adjacent vertebral bodies within 6 months of treatment. The pattern of the involved vertebral body collapse in tuberculosis of the lumbar and lumbosacral joints was vertical (telescoping), along a longitudinal axis that minimized the progression of kyphosis. The outcome was judged on the basis of residual kyphosis (British Medical Research Council criteria) and found to be favorable in 96.4% (54 patients). Triple chemotherapy for lumbar and lumbosacral tuberculosis is effective in curing the disease and in minimizing the residual kyphosis through early diagnosis and immediate initiation of chemotherapy. The pattern of vertebral body collapse is the telescoping type, which is the determining factor in minimizing residual spinal deformity.
56例腰椎及腰骶椎活动性结核的成年人（平均年龄38岁）接受了三联化疗保守治疗12至18个月。最短随访时间为3年。采用三种方法在患者站立位获得的腰椎侧位X线片上评估矢状面脊柱畸形的时间变化：畸形、后凸角和腰椎总前凸。测量腰骶关节结核的腰骶关节角。所有患者病情均愈合，后凸增加最少，尽管23例患者在治疗后6个月内相邻椎体有轻微新受累。腰椎及腰骶关节结核中受累椎体塌陷的模式是垂直的（套叠式），沿着使后凸进展最小化的纵轴。根据残留后凸（英国医学研究委员会标准）判断结果，96.4%（54例患者）结果良好。腰椎及腰骶椎结核的三联化疗通过早期诊断和立即开始化疗，在治愈疾病和使残留后凸最小化方面是有效的。椎体塌陷模式为套叠式，这是使残留脊柱畸形最小化的决定因素。
