Orthopedics Research Institute of the Chinese People's Liberation Army, Orthopedics Department of Changzheng Hospital, Changzheng, China.
Int Orthop. 2012 Feb;36(2):367-72. doi: 10.1007/s00264-011-1438-9. Epub 2012 Jan 4.
The outcomes of surgical treatment and related complications of post-tubercular kyphotic (PTK) deformity of the cervical spine or the cervico-thoracic spine were evaluated.
From January 2005 to October 2010, 12 cases with PTK (7 males, 5 females) with an average age of 30 years (range 21-43 years) formed the study group. There were ten patients with cervical deformities and two with cervico-thoracic kyphosis. Neurological function of all the patients was evaluated by the Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score. Two patients with severe cervico-thoracic deformity received modified skeleton traction pre-operatively. Ten patients underwent anterior debridement and reconstruction, using iliac crest or cages with autografts, while two patients with cervico-thoracic kyphosis received posterior instrumentation and fusion.
The mean pre-operative focal kyphotic angle was 42.58° (range 30-67°), reducing to -8° (range -15-11°) postoperatively (at the last follow-up visit). The average operating time was 117.50 min (80-200 min) with an average blood loss of 110 ml (range 50-300 ml). Neurological assessment of all the patients, using the Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score, was improved significantly after surgery. All patients had solid fusion and no major complication was observed in the follow-up.
One-stage anterior debridement, instrumentation and fusion for cervical spinal TB and single posterior instrumentation for cervico-thoracic spinal TB followed by chemotherapy is practical to correct PTK. The procedure has the advantage of lower blood loss, effective kyphosis correction and minimal complications. To patients with severe deformity, skeletal traction seemed indispensible.
评估手术治疗及相关并发症在肺结核后脊柱后凸畸形（PTK）颈椎或颈胸段的疗效。
2005 年 1 月至 2010 年 10 月，12 例肺结核后颈椎或颈胸段 PTK 患者（男 7 例，女 5 例）纳入研究，平均年龄 30 岁（21-43 岁）。10 例颈椎畸形，2 例颈胸段后凸。所有患者均通过日本矫形协会（JOA）评分和视觉模拟评分（VAS）评估神经功能。2 例严重颈胸段畸形患者术前接受改良骨骼牵引。10 例患者行前路清创和重建，使用髂嵴或自体移植物，2 例颈胸段后凸患者行后路器械和融合。
术前局灶性后凸角平均为 42.58°（30-67°），术后（末次随访）为-8°（-15-11°）。平均手术时间 117.50 分钟（80-200 分钟），平均失血量 110ml（50-300ml）。所有患者的日本矫形协会（JOA）评分和视觉模拟评分（VAS）神经功能评估均明显改善。所有患者均获得可靠融合，随访无重大并发症。
颈椎结核一期前路清创、器械和融合，颈胸段结核一期后路器械融合后化疗，是纠正 PTK 的实用方法。该方法具有出血少、后凸矫正效果好、并发症少的优点。对于严重畸形的患者，骨骼牵引似乎是必不可少的。
