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椎体皮质剥除术治疗脊柱结核所致锐性角状脊柱畸形：病例报告

Vertebral column decortication for the management of sharp angular spinal deformity in Pott disease: Case report.

作者信息

Hu Hong-Tao, Liu Feng-Yu, Yu Jin-He, Ren Liang, Gu Zhen-Fang, Sun Xian-Ze

机构信息

Department of Spine Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China.

出版信息

Medicine (Baltimore). 2017 Nov;96(45):e8592. doi: 10.1097/MD.0000000000008592.

DOI:10.1097/MD.0000000000008592
PMID:29137084
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5690777/
Abstract

RATIONALE

Extremely sharp angular spinal deformity of healed tuberculosis can be corrected by vertebral column resection (VCR). However, the VCR techniques have many limitations including spinal column instability, greater blood loss, and greater risk of neurologic deficit.

PATIENT CONCERNS

We described a new spinal osteotomy technique to collect sharp angular spinal deformity in Pott disease. A 52-year-old woman presented with back pain and gait imbalance.

DIAGNOSIS

The kyphosis of healed tuberculosis was diagnosed based on history and imaging examinations.

INTERVENTION

A new posterior VCR was designed to treat this disease.

OUTCOMES

The neurological function improved from Japanese Orthopedic Association scale 3 to 7. The back pain and neurological function were significantly improved. The Oswestry Disability Index decreased from 92 to 34. There was also a significant decrease in back pain visual analog scale from 9 to 2.

LESSONS

For cases with extremely severe Pott kyphotic deformity, the technology of modified VCR offers excellent clinical and radiographic results.

摘要

理论依据

愈合型结核导致的极其尖锐的角状脊柱畸形可通过脊柱切除术（VCR）进行矫正。然而，VCR技术存在许多局限性，包括脊柱不稳定、失血量大以及神经功能缺损风险更高。

患者情况

我们描述了一种新的脊柱截骨技术，用于矫正脊柱结核中的尖锐角状脊柱畸形。一名52岁女性出现背痛和步态失衡。

诊断

根据病史和影像学检查诊断为愈合型结核后凸畸形。

干预措施

设计了一种新的后路VCR来治疗这种疾病。

结果

神经功能从日本骨科协会3级改善到7级。背痛和神经功能明显改善。奥斯维斯特里功能障碍指数从92降至34。背痛视觉模拟量表评分也从9显著降至2。

经验教训

对于极其严重的脊柱结核后凸畸形病例，改良VCR技术可提供出色的临床和影像学效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/60dd91606c58/medi-96-e8592-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/7668d3253435/medi-96-e8592-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/e94d9bc3a6e4/medi-96-e8592-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/242f1bc35c72/medi-96-e8592-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/22dd9510f147/medi-96-e8592-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/41b5346d215b/medi-96-e8592-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/60dd91606c58/medi-96-e8592-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/7668d3253435/medi-96-e8592-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/e94d9bc3a6e4/medi-96-e8592-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/242f1bc35c72/medi-96-e8592-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/22dd9510f147/medi-96-e8592-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/41b5346d215b/medi-96-e8592-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3537/5690777/60dd91606c58/medi-96-e8592-g006.jpg

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本文引用的文献

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Eur Spine J. 2014 Mar;23(3):708-10. doi: 10.1007/s00586-014-3225-y.
2
Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site.肺结核相关性后凸畸形的晚期治疗：文献回顾及 SRS-GOP 站点经验。
Eur Spine J. 2013 Jun;22 Suppl 4(Suppl 4):641-6. doi: 10.1007/s00586-012-2338-4. Epub 2012 May 25.
3
Clinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years' follow-up in the MRC study long enough?
保守治疗结核性脊柱炎的临床和影像学结果：MRC 研究的 15 年随访时间足够长吗？
Eur Spine J. 2013 Jun;22 Suppl 4(Suppl 4):594-602. doi: 10.1007/s00586-012-2332-x. Epub 2012 May 8.
4
Vertebral column decancellation for the management of sharp angular spinal deformity.脊柱后凸切除矫正术治疗严重脊柱角状畸形
Eur Spine J. 2011 Oct;20(10):1703-10. doi: 10.1007/s00586-011-1771-0. Epub 2011 Mar 19.
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Closing-opening wedge osteotomy for severe, rigid, thoracolumbar post-tubercular kyphosis.闭合-撑开楔形截骨术治疗严重、僵硬的胸腰椎结核后凸畸形。
Eur Spine J. 2011 Mar;20(3):343-8. doi: 10.1007/s00586-010-1526-3. Epub 2010 Aug 18.
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Posterior-only multilevel modified vertebral column resection for extremely severe Pott's kyphotic deformity.仅后路多级改良脊柱切除术治疗极重度脊柱结核后凸畸形
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