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[特异性脊柱炎]

[Specific spondylitis].

作者信息

Bullmann V, Liljenqvist U R, Koriller M, Lange T

机构信息

Orthopädische Klinik II - Wirbelsäulenchirurgie, St. Franziskus-Hospital, Schönsteinstr. 63, 50825, Köln-Ehrenfeld, Deutschland.

出版信息

Orthopade. 2012 Sep;41(9):764-9. doi: 10.1007/s00132-012-1921-z.

Abstract

Tuberculosis of the spine usually occurs with a latency period after primary infection with tuberculosis (TB) and the most frequent agent is Mycobacterium tuberculosis. The rate of TB has increased due to the impact of acquired immunodeficiency syndrome (AIDS) and more than 50% of skeletal tuberculosis is localized in the spine. Spinal tuberculosis was discovered by Pott in 1776. Magnetic resonance imaging (MRI) with gadolineum is the most sensitive imaging method. Diagnostic accuracy is given by direct detection of Mycobacterium tuberculosis by punction or biopsy. Granuloma of the spine can lead to abscesses, severe spinal deformity with instability and potentially paraplegia. Chemotherapy is effective with a minimum duration of 6-12 months. In cases with neurological deficits and severe deformity there is an additional indication for surgical therapy. In the acute phase a posterior instrumentation, anterior debridement and reconstruction of the defect is indicated. After recovery of the spinal tuberculosis Pott's kyphosis could remain and operative correction can be managed by pedicle substraction osteotomy.

摘要

脊柱结核通常在原发性结核感染后有一段潜伏期,最常见的病原体是结核分枝杆菌。由于获得性免疫缺陷综合征(AIDS)的影响,结核病发病率有所上升,超过50%的骨结核局限于脊柱。脊柱结核于1776年由波特发现。钆增强磁共振成像(MRI)是最敏感的成像方法。通过穿刺或活检直接检测结核分枝杆菌可提高诊断准确性。脊柱肉芽肿可导致脓肿、严重脊柱畸形伴不稳定,并可能导致截瘫。化疗有效,最短疗程为6至12个月。对于有神经功能缺损和严重畸形的病例,有额外的手术治疗指征。在急性期,建议进行后路内固定、前路清创和缺损重建。脊柱结核恢复后可能会残留波特氏后凸畸形,可通过椎弓根截骨术进行手术矫正。

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