Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, SAR, China.
Eur Spine J. 2013 Jun;22 Suppl 4(Suppl 4):603-11. doi: 10.1007/s00586-012-2455-0. Epub 2012 Aug 16.
Spinal tuberculosis represents a challenging disease to treat, not because of the technical expertise or the time required to cure it, but more so because of the decisions involved to treat it. The Medical Research Council (MRC) Working Party on Tuberculosis of the Spine designed trials to help address several questions.
A comprehensive literature search was performed using PubMed Medline, including English articles from 1934 to 1012, which pertain to spinal tuberculosis, with special effort in tracing the 13 MRC reports. The primary focus was on disease eradication, fusion rate, and a secondary focus on both short and long-term results in terms of disease recurrence and alignment. Additional searches were made on the use of spinal implants for infection cases.
After reviewing MRC and non-MRC reports, it was evident that the "Hong Kong operation", which involved radical debridement and strut grafting the lesion, produced better short-, medium- and long-term results in such aspects as fusion rate, spinal deformity and relapse of abscess/sinus. Subsequent work by others demonstrated the importance of prevention of progressive kyphosis, therefore the need to identify risk factors for these and pre-emptive measures such as kyphosis correction, careful graft selection, and instrumentation.
Improvement in quality of life is also accompanied by higher patient expectations. Though developing nations may lack the resources now, eventually patients will demand better functional and cosmetic results after being afflicted by this disfiguring and potentially disabling disease, and the "Hong Kong operation" represented the best outcome, provided resources were available.
脊柱结核的治疗极具挑战性，这并非因为治愈它需要专业的技术知识或耗费大量时间，而是因为在治疗过程中需要做出许多决策。为此，医学研究委员会（MRC）脊柱结核工作组设计了一些临床试验来解答相关疑问。
通过PubMed Medline 数据库进行了全面的文献检索，检索内容涵盖了 1934 年至 2012 年间与脊柱结核相关的所有英文文献，并重点追踪了 13 份 MRC 报告。研究主要集中在疾病的清除率、融合率上，次要重点则是疾病复发和脊柱排列的短期、中期和长期结果。还对脊柱植入物在感染病例中的应用进行了额外的搜索。
在对 MRC 和非 MRC 报告进行审查后，明显发现“香港手术”（包括彻底清创和病变部位支撑植骨）在融合率、脊柱畸形和脓肿/窦道复发等方面的短期、中期和长期结果更好。随后，其他人的研究表明，预防进行性后凸畸形非常重要，因此需要确定这些风险因素，并采取预防措施，如后凸矫正、仔细选择植骨材料和使用器械。
生活质量的提高也伴随着患者更高的期望。虽然发展中国家目前可能缺乏资源，但随着时间的推移，患者在遭受这种致残和潜在致残疾病后，将要求获得更好的功能和美容效果，而“香港手术”在资源允许的情况下，提供了最佳的结果。
