Department of Neurosurgery, Johns Hopkins Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Spine (Phila Pa 1976). 2011 Aug 1;36(17):1420-5. doi: 10.1097/BRS.0b013e3181f2a2c6.
Review of historical archival records.
Describe Harvey Cushing's patients with spinal pathology.
Harvey Cushing was a pioneer of modern surgery but his work on spine remains largely unknown.
Review of the Chesney Medical Archives of the Johns Hopkins Hospital from 1896 to 1912.
This is the first time that Cushing's spinal cases while he was at the Johns Hopkins Hospital, including those with Pott disease, have been described.Cushing treated three young men with psoas abscesses secondary to Pott disease during his residency: he drained the abscesses, debrided any accompanying necrotic vertebral bodies, irrigated the cavity with salt, and left the incision open to close by secondary intention. Although Cushing used Koch's "tuberculin therapy" (of intravenous administration of isolated tubercular bacilli) in one patient, he did not do so in the other two, likely because of the poor response of this first patient. Later in his tenure, Cushing performed a laminectomy on a patient with kyphosis and paraplegia secondary to Pott disease.
These cases provide a view of Cushing early in his career, pointing to the extraordinary degree of independence that he had during his residency under William Steward Halsted; these cases may have been important in the surgical upbringing both of Cushing and his coresident, William Stevenson Baer, who became the first professor of Orthopedics at Johns Hopkins Hospital. At the turn of the last century, Pott disease was primarily treated by immobilization with bed rest, braces, and plaster-of-paris jackets; some surgeons also employed gradual correction of the deformity by hyperextension. Patients who failed a trial of conservative therapy (of months to years) were treated with a laminectomy. However, the limitations of these strategies led to the development of techniques that form the basis of contemporary spine surgery-instrumentation and fusion.
回顾历史档案记录。
描述哈维·库欣（Harvey Cushing）脊柱病变患者的情况。
哈维·库欣（Harvey Cushing）是现代外科手术的先驱，但他在脊柱方面的工作在很大程度上仍不为人知。
回顾约翰霍普金斯医院切斯尼医学档案馆（Chesney Medical Archives）1896 年至 1912 年的记录。
这是第一次描述库欣（Cushing）在约翰霍普金斯医院（Johns Hopkins Hospital）时的脊柱病例，包括波特氏病（Pott disease）患者。库欣（Cushing）在住院医师期间治疗了三名患有由波特氏病引起的腰大肌脓肿的年轻男性：他引流脓肿，清创任何伴随的坏死椎体，用盐水冲洗腔，并使切口敞开，以便二期愈合。尽管库欣（Cushing）在一名患者中使用了科赫（Koch）的“结核菌素疗法”（静脉内给予分离的结核杆菌），但在另外两名患者中没有这样做，可能是因为第一个患者的反应不佳。在他任期的后期，库欣（Cushing）对一名因波特氏病引起后凸畸形和截瘫的患者进行了椎板切除术。
这些病例提供了库欣（Cushing）职业生涯早期的一个视角，表明他在威廉·斯图尔特·霍尔斯特德（William Steward Halsted）指导下住院期间具有非凡的独立性；这些病例对于库欣（Cushing）及其住院医师威廉·史蒂文森·贝尔（William Stevenson Baer）的外科培养都可能很重要，后者成为约翰霍普金斯医院（Johns Hopkins Hospital）的第一任骨科教授。在上个世纪之交，波特氏病主要通过卧床休息、支具和石膏背心固定来治疗；一些外科医生还通过过度伸展逐渐矫正畸形。经过数月至数年的保守治疗（保守治疗）尝试失败的患者接受了椎板切除术治疗。然而，这些策略的局限性导致了当代脊柱手术器械和融合技术的发展。
