Li Jing, Lü Guo-hua, Wang Xiao-bin, Wang Bing, Lu Chang, Deng You-wen
Department of Spine Surgery, Second Xiangya Hospital of Central South University, Changsha, China.
Zhonghua Wai Ke Za Zhi. 2010 Apr 15;48(8):597-600.
To explore an effective and reasonable surgical strategy for active spinal tuberculosis with severe kyphotic deformity (kyphotic angle >or= 45 degrees).
From January 2004 to January 2008, 30 consecutive patients of active spinal tuberculosis complicated with significant angulation were enrolled in this study, including 8 male and 22 female. The average age was 35 years (range, 7 - 60 years), with average angle of kyphosis of 58 degrees (range, 45 degrees - 70 degrees). There were 28 patients complicated with intraspinal abscess, of which 10 patients presented with incomplete paraplegia. According to the Frankel's scoring system, there were 2 patients with Frankel Grade B, 6 with Grade C, 2 with Grade D. After antituberculous chemotherapy (HREZ) for at least 2 weeks, all patients underwent posterior multiple-level pedicle screw instrumentation and kyphotic correction, and then received anterior debridement, decompression and supportive bone grafting, all of which were completed in the same day. The postoperative standardized chemotherapy was 6HREZ/6-12HRE. The angle of kyphosis, curve correction after surgery, and recovery of paraplegia were analyzed. Fusion status and erythrocyte sedimentation rate were recorded to determine the presence of active disease.
Operative time was 4 to 6 hours (average 5.2 h), blood loss was 600 to 900 ml (average 760 ml). No perioperative severe complications occurred. The kyphotic angle was corrected to 0 degrees - 10 degrees, and the maximum corrected angle was 65 degrees . The average follow-up duration was 18 months (range, 12 - 48 m). All patients showed evidence of solid fusion and healing of the active disease at 6 months follow-up. Neurologic deficits were improved: 2 patients from B to D, 6 patients from C to E, 2 patients from D to E. No recurrence of the tuberculosis infection or instrumentation failure happened at final follow-up.
Combined posterior instrumentation and anterior debridement, fusion surgery in one stage is proved to be successful in treating spinal tuberculosis, correcting the kyphosis, and providing solid fusion.
探讨一种针对重度后凸畸形（后凸角≥45度）的活动性脊柱结核的有效且合理的手术策略。
2004年1月至2008年1月，本研究纳入30例连续的活动性脊柱结核合并显著成角的患者，其中男性8例，女性22例。平均年龄35岁（范围7 - 60岁），平均后凸角58度（范围45度 - 70度）。28例患者合并椎管内脓肿，其中10例患者出现不完全性截瘫。根据Frankel评分系统，Frankel B级2例，C级6例，D级2例。在至少2周的抗结核化疗（HREZ）后，所有患者均接受后路多级椎弓根螺钉内固定及后凸矫正，然后进行前路清创、减压及支撑性植骨，所有操作均在同一天完成。术后标准化化疗为6HREZ/6 - 12HRE。分析后凸角、术后曲线矫正及截瘫恢复情况。记录融合状态及红细胞沉降率以确定是否存在活动性疾病。
手术时间为4至6小时（平均5.2小时），失血量为600至900毫升（平均760毫升）。围手术期未发生严重并发症。后凸角矫正至0度 - 10度，最大矫正角度为65度。平均随访时间为18个月（范围12 - 48个月）。所有患者在随访6个月时均显示有牢固融合且活动性疾病愈合。神经功能缺损得到改善：2例从B级改善至D级，6例从C级改善至E级，2例从D级改善至E级。末次随访时未发生结核感染复发或内固定失败。
后路内固定与前路清创、融合一期手术被证明在治疗脊柱结核、矫正后凸及提供牢固融合方面是成功的。
