Janssens J P, de Haller R
Department of Medicine, University Hospital, Geneva, Switzerland.
Clin Orthop Relat Res. 1990 Aug(257):67-75.
A retrospective study of 26 cases was analyzed to review the sometimes unfamiliar clinical appearance and outcome of Pott's disease. Swiss nationals (46%) were older than patients from Mediterranean or developing countries (mean age, 69 versus 29 years). The number of vertebrae initially involved was 2.2. Localization was lumbar in ten cases, thoracic and lumbar in two, and thoracic or cervical in 14. Abscesses were present in 15 (57%) subjects and appeared during treatment in 20% of these cases. They were twice as frequent in non-Swiss patients. Three patients had surgery because of progression of the abscess under treatment. Ten cases needed single or multiple aspirations. Three of six lumbar abscesses were initially visualized only by computed tomography. Neurologic complications occurred in 12 (46%) patients, 11 of whom had cervical or thoracic vertebrae involved. In four cases (33%), the neurologic deficit developed during the first two months of treatment. Three patients had laminectomies, two without any benefit. Outcome was favorable for 11 of 12 patients without any difference between conservative treatment and surgery. Neurologic symptoms are in most cases related to radicular and medullary inflammation, with arachnoiditis and without compression. The possible benefit of steroids seems promising enough to warrant further investigation.
对26例病例进行回顾性研究，以审视波状热有时不为人熟悉的临床表现及转归。瑞士籍患者（46%）的年龄大于来自地中海地区或发展中国家的患者（平均年龄分别为69岁和29岁）。最初受累椎体数量为2.2个。病变部位为腰椎的有10例，胸腰段的有2例，胸段或颈段的有14例。15例（57%）患者存在脓肿，其中20%的脓肿在治疗期间出现。非瑞士籍患者中脓肿的发生率是瑞士籍患者的两倍。3例患者因治疗期间脓肿进展而接受手术。10例患者需要进行单次或多次穿刺抽吸。6例腰椎脓肿中有3例最初仅通过计算机断层扫描才得以显影。12例（46%）患者发生神经并发症，其中11例的病变累及颈椎或胸椎。4例（33%）患者的神经功能缺损在治疗的头两个月内出现。3例患者接受了椎板切除术，其中2例未见任何改善。12例患者中有11例预后良好，保守治疗和手术治疗之间无差异。多数情况下，神经症状与神经根及脊髓炎症相关，伴有蛛网膜炎但无压迫。类固醇可能带来的益处似乎很有前景，值得进一步研究。
