Soares do Brito Joaquim, Batista Nuno, Tirado António, Fernandes Pedro
Unidade de Coluna. Serviço de Ortopedia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte, EPE. Lisboa. Portugal..
Acta Med Port. 2013 Jul-Aug;26(4):349-56. Epub 2013 Aug 30.
Tuberculosis is responsible for more than 40% of spine infections. While tuberculostatic chemotherapy remains the gold-standard treatment, surgical intervention is necessary only in specific cases. This paper reports the results of 33 patients with spine tuberculosis operated in our department in the last 15 years.
Evaluate retrospectively patients with spine tuberculosis operated in the last 15 years - from 1996 to 2011; evaluate the surgical options, infection resolution results, deformity correction, functional results and outcome in cases of neurological injury.
Analysis of clinical and radiological assessments of patients diagnosed with spine tuberculosis and operated between 1996 and 2011. In this period 33 patients were operated with average age of 46.7 years; 17 patients had thoracic infection, 11 patients lumbar infection and 5 thoraco-lumbar infection. Paravertebral abscess was identified in 26 cases with intracanal extension in 16 patients. Nine patients had neurological injury. The anterior surgical approach was used in seven cases, the posterior approach in 11 and anterior-posterior approach was preferred in 15 occasions. Antituberculous chemotherapy was maintained on average for 14 months, with mean follow up of 24 months.
The infection was eradicated in all patients. Bone fusion was found in average at 10.6 months follow-up. The anterior approach did not produce correction of the initial deformity, while the posterior approach allowed average correction of 12.7° and the anterior-posterior approach a mean correction of 8.7°. Five patients with neurological injury experienced improvement of 2 or 3 levels in ASIA score. We also report complications in two cases where superficial wound infection was diagnosed.
Treatment with antituberculosis drugs is the first-line therapy in the treatment of tuberculous spondylodiscitis, while surgical treatment has specific indications. The surgical option, when indicated, allows deformity correction and bone fusion. The anterior-posterior or only posterior surgical approach is preferred in this context. The complication rate was not significant despite the introduction of osteosynthesis hardware.
脊柱感染中超过40%由结核病引起。虽然抗结核化疗仍是金标准治疗方法，但仅在特定情况下才需要手术干预。本文报告了过去15年在我科接受手术治疗的33例脊柱结核患者的结果。
回顾性评估1996年至2011年过去15年中接受脊柱结核手术的患者；评估手术选择、感染消除结果、畸形矫正、功能结果以及神经损伤病例的预后。
分析1996年至2011年间诊断为脊柱结核并接受手术治疗的患者的临床和影像学评估。在此期间，33例患者接受了手术，平均年龄46.7岁；17例患者为胸椎感染，11例为腰椎感染，5例为胸腰段感染。26例患者发现椎旁脓肿，16例患者有椎管内扩展。9例患者有神经损伤。7例采用前路手术，11例采用后路手术，15例优先采用前后路联合手术。抗结核化疗平均持续14个月，平均随访24个月。
所有患者感染均被根除。平均随访10.6个月时发现骨融合。前路手术未矫正初始畸形，而后路手术平均矫正12.7°，前后路联合手术平均矫正8.7°。5例神经损伤患者的美国脊髓损伤协会（ASIA）评分提高了2或3个等级。我们还报告了2例诊断为浅表伤口感染的并发症。
抗结核药物治疗是结核性脊椎间盘炎的一线治疗方法，而手术治疗有特定指征。手术选择在有指征时可实现畸形矫正和骨融合。在此情况下，优先选择前后路联合或仅后路手术。尽管引入了内固定器械，但并发症发生率并不高。
