Rajasekaran S
Department of Orthopaedics and Spine Surgery, Ganga Medical Centre, Coimbatore, India.
Clin Orthop Relat Res. 2002 May(398):85-92. doi: 10.1097/00003086-200205000-00012.
Spinal tuberculosis is the most common cause for a kyphotic deformity in patients in many parts of the world. There is an average increase of 15 degrees deformity in all patients who are treated conservatively and 3% to 5% of patients may end up with a deformity that is greater than 60 degrees. The progress of deformity occurs in two distinct phases: Phase I, which includes the changes in the active phase, and Phase II, which includes changes after the disease is cured. The progress of deformity is influenced by the severity of the angle before treatment, the level of the lesion, and age of the patient. Adults have an increase less than 30 degrees during the active phase with no additional change. Children, in contrast, have significant changes even in the healed phase of the disease. During the growth spurt, there is worsening of the deformity in 39% (Type I progression), an improvement in 44% (Type II), and no change in 17% (Type III). Children at risk of late progressive deformity can be identified early by the presence of spine-at-risk radiologic signs. Surgery for preventing deformity must be done earlier rather than later and in patients with severe disease, stabilization by the use of posterior and anterior instrumentation is necessary to obtain a good outcome.
脊柱结核是世界上许多地区患者脊柱后凸畸形最常见的病因。所有接受保守治疗的患者平均畸形增加15度，3%至5%的患者最终可能出现大于60度的畸形。畸形进展分两个不同阶段：第一阶段包括活动期的变化，第二阶段包括疾病治愈后的变化。畸形进展受治疗前角度严重程度、病变部位及患者年龄影响。成年人在活动期畸形增加小于30度且无额外变化。相比之下，儿童即使在疾病愈合期也有显著变化。在生长突增期，39%的患者畸形加重（I型进展），44%的患者畸形改善（II型），17%的患者畸形无变化（III型）。存在脊柱危险放射学征象可早期识别有晚期进展性畸形风险的儿童。预防畸形的手术必须尽早而非推迟进行，对于重症患者，使用前后路内固定进行稳定是获得良好效果所必需的。
