毗邻多节段脊柱结核的手术策略和治疗结果：48 例回顾性研究。

Surgical strategy and management outcomes for adjacent multisegmental spinal tuberculosis: a retrospective study of forty-eight patients.

机构信息

*Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China †Department of Orthopaedics, The 309th Hospital of the PLA, Beijing, China; and ‡Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.

出版信息

Spine (Phila Pa 1976). 2014 Jan 1;39(1):E40-8. doi: 10.1097/BRS.0000000000000053.

DOI:10.1097/BRS.0000000000000053

PMID:24108290

Abstract

STUDY DESIGN

Retrospective study.

OBJECTIVE

To evaluate the clinical outcomes of 4 different procedures for the treatment of adjacent multisegmental spinal tuberculosis (AMSST) and to investigate the selection strategy of the optimal procedure with respect to focal characteristics.

SUMMARY OF BACKGROUND DATA

Because of the lack of support of the anterior columns of multiple segments, AMSST is thought to confer high risks for the development of kyphosis and paraplegia. However, there are few reports regarding the clinical outcomes of the surgical treatment for AMSST have been investigated.

METHODS

From August 1999 to June 2010, 48 patients with AMSST were enrolled in this study. Seven patients (A group) underwent a single-stage anterior operation. Eighteen patients (AP group) underwent a single-stage posterior and anterior combined operation. Eighteen patients (P group) underwent a single-stage posterior operation. Five patients (DP group) underwent computed tomography-guided drainage and local chemotherapy combined with a 2-stage posterior operation. The patients were followed up clinically and radiologically for an average of 29.6 months.

RESULTS

The cohort consisted of 29 males and 19 females, aged 4 to 54 years. The patients exhibited significant improvements in deformity and neurological deficits. Graft union was achieved in all patients 5 to 12 months postoperatively. Surgery-related complications were noted in 1 and 2 patients in the AP and P groups, respectively. Postoperative recurrence occurred in 1 and 2 patients in the AP and P groups, respectively. All 48 patients had been cured at the final follow-up.

CONCLUSION

This study demonstrated that the 4 procedures can safely and effectively achieve nerve decompression, graft fusion, and kyphosis correction. Individualized procedures should be chosen according to the patient's general condition, focal characteristic, type of complication, and surgeon's experience.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性研究。

目的

评估治疗相邻多节段脊柱结核（AMSST）的 4 种不同手术方法的临床效果，并探讨根据病变特点选择最佳手术方法的策略。

背景资料概要

由于多个节段的前柱缺乏支撑，AMSST 被认为有发生后凸畸形和截瘫的高风险。然而，关于手术治疗 AMSST 的临床效果的报道较少。

方法

自 1999 年 8 月至 2010 年 6 月，共有 48 例 AMSST 患者纳入本研究。其中 7 例（A 组）接受一期前路手术，18 例（AP 组）接受一期前后联合手术，18 例（P 组）接受一期后路手术，5 例（DP 组）接受 CT 引导下引流和局部化疗联合二期后路手术。所有患者平均随访 29.6 个月。

结果

该队列包括 29 例男性和 19 例女性，年龄 4 岁至 54 岁。患者的畸形和神经功能缺损均有明显改善。所有患者术后 5 至 12 个月均获得植骨融合。AP 组和 P 组各有 1 例和 2 例患者出现手术相关并发症。AP 组和 P 组各有 1 例和 2 例患者术后复发。所有 48 例患者最终随访时均治愈。