Soares Do Brito Joaquim, Tirado António, Fernandes Pedro
Orthopaedic and Trauma Resident.
Orthopaedic and Trauma Specialist.
Iowa Orthop J. 2014;34:129-36.
Tuberculosis can be responsible for extensive spinal lesions. Despite the efficacy of medical treatment, surgery is indicated to avoid or correct significant deformity, treat spinal instability, prevent neurological compromise, and to eradicate an extensive tuberculous abscess. In this paper we present our experience in the surgical management of spinal tuberculosis complicated with large abscess.
Fifteen patients with spinal tuberculosis complicated with extensive abscess were identified; and nine of those patients had extension of the infection into the epidural space. The average age at treatment was 34 years old. Seven patients had thoracic infection, seven patients had lumbar infection and one had thoracolumbar infection. Six patients had neurological deficit at presentation. All patients were surgically treated with abscess debridement, spinal stabilization and concurrent antituberculous chemotherapy. A single anterior surgical approach was used in three cases, a posterior approach was used in four others and a combined approach was performed in eight patients.
Surgical management allowed for effective abscess debridement and sspinal stabilization in this cohort. In combination with antituberculous drugs, surgical treatment resulted in infection eradication and bone fusion in all patients at 24 month average follow-up. Satisfactory neurological outcomes with improved American Spinal Injury Association (ASIA) scores were observed in 100% of patients.
Surgical treatment for spinal tuberculosis abscess can lead to satisfactory clinical outcomes.
结核病可导致广泛的脊柱病变。尽管药物治疗有效，但仍需手术以避免或纠正严重畸形、治疗脊柱不稳定、预防神经功能损害并根除广泛的结核性脓肿。在本文中，我们介绍了我们在手术治疗合并大脓肿的脊柱结核方面的经验。
确定了15例合并广泛脓肿的脊柱结核患者；其中9例患者的感染蔓延至硬膜外间隙。治疗时的平均年龄为34岁。7例患者为胸椎感染，7例为腰椎感染，1例为胸腰段感染。6例患者就诊时存在神经功能缺损。所有患者均接受了脓肿清创、脊柱稳定术及同时进行的抗结核化疗。3例采用单一前路手术入路，4例采用后路手术入路，8例采用联合手术入路。
手术治疗使该队列患者的脓肿得到有效清创并实现了脊柱稳定。在抗结核药物的联合治疗下，手术治疗使所有患者在平均24个月的随访期内实现了感染根除和骨融合。100%的患者神经功能恢复良好，美国脊髓损伤协会（ASIA）评分提高。
脊柱结核脓肿的手术治疗可取得满意的临床效果。
