Jutte Paul, Wuite Sander, The Bertram, van Altena Richard, Veldhuizen Albert
Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Clin Orthop Relat Res. 2007 Feb;455:196-201. doi: 10.1097/01.blo.0000246559.27596.33.
Tuberculosis of the spine may cause kyphosis, which may in turn cause late paraplegia, respiratory compromise, and unsightly deformity. Surgical correction therefore may be considered for large or progressive deformities. We retrospectively analyzed clinical and radiographic parameters to predict the final kyphotic angle in spinal tuberculosis and to identify patients at risk of unfavorable outcomes at an early stage of the disease when surgery may be indicated. Unfavorable outcome was defined as progression of 10 degrees or greater and/or a final angle of 40 degrees or greater. We analyzed 53 patients with active spinal tuberculosis located in the thoracic (T1 to T10) and thoracolumbar spine (T11 to L2) and with initial kyphotic angles less than 40 degrees. We calculated the indexed total bone height loss, a value of 1 being the equivalent of the loss of a total vertebral body. There were no independent predictors. A bone height loss greater than 0.3 on the initial radiograph in combination with a thoracolumbar location indicated a 38% chance of unfavorable outcome versus only a 3% chance of unfavorable outcome when bone height loss was 0.3 or less in combination with a thoracic location. We present a simple and clinically useful algorithm for predicting kyphosis in spinal tuberculosis.
脊柱结核可能导致脊柱后凸，进而可能引起迟发性截瘫、呼吸功能不全以及难看的畸形。因此，对于严重或进行性畸形可考虑手术矫正。我们回顾性分析了临床和影像学参数，以预测脊柱结核的最终后凸角度，并在疾病早期可能需要手术时识别出预后不良风险的患者。不良预后定义为进展10度或更大和/或最终角度40度或更大。我们分析了53例活动性脊柱结核患者，病变位于胸椎（T1至T10）和胸腰椎（T11至L2），初始后凸角度小于40度。我们计算了指数化的总骨高度丢失，1的值相当于一个椎体的丢失。没有独立的预测因素。初始X线片上骨高度丢失大于0.3且病变位于胸腰椎时，预后不良的几率为38%，而当骨高度丢失为0.3或更低且病变位于胸椎时，预后不良的几率仅为3%。我们提出了一种简单且临床实用的算法来预测脊柱结核的后凸畸形。
